Breast implants are medical devices placed in the chest to augment or reconstruct breast size and shape. While generally safe, one recognized complication following breast augmentation or reconstruction surgery is capsular contracture. This condition involves the formation of a tightened scar tissue capsule around the implant.
Understanding Capsular Contracture
The human body naturally responds to any foreign object, such as a breast implant, by forming a protective layer of scar tissue around it. This fibrous capsule is a normal physiological response, creating a barrier between the implant and surrounding tissues. Capsular contracture develops when this normally soft and pliable capsule begins to harden and constrict around the implant. This tightening can compress the implant, leading to various changes in the breast’s appearance and feel.
The severity of capsular contracture is classified using the Baker grading system, which ranges from Grade I to Grade IV:
Grade I: The breast feels normally soft and appears natural.
Grade II: The breast feels firm to the touch but still looks normal.
Grade III: The breast feels firm and presents with visible distortion, often appearing rounded or unnaturally high.
Grade IV: The breast is hard, painful, and significantly distorted in shape.
Primary Causes and Contributing Factors
Capsular contracture is a complex condition with multiple factors that contribute to its development. One prominent theory involves subclinical bacterial contamination, specifically biofilm formation on the implant surface. Biofilms are communities of bacteria encased in a protective matrix, triggering a chronic inflammatory response that leads to excessive scar tissue formation and contraction.
Post-surgical complications like hematoma (a collection of blood) or seroma (an accumulation of fluid) around the implant can also increase the risk. These fluid collections provide a medium that can promote bacterial growth or induce an inflammatory cascade, contributing to the thickening and tightening of the capsule. An undetected or untreated rupture of a breast implant, especially silicone gel implants, can also lead to contracture. The leakage of silicone particles into the surrounding tissue can provoke a strong inflammatory or immune reaction, stimulating the body to encapsulate and wall off these foreign substances with dense scar tissue.
The individual patient’s immune response and genetic predisposition play a role in how their body reacts to the implant material. Some individuals may have a heightened inflammatory response, leading to more aggressive scar tissue formation. The type and surface of the implant also influence risk. For instance, saline implants may have a slightly lower incidence compared to silicone. While textured implants were once thought to reduce contracture rates, they have been linked to other rare complications, and smooth implants may have a higher rate of contracture.
Surgical technique during the initial augmentation procedure also contributes to contracture risk. Meticulous surgical practices, including minimizing tissue trauma, precise pocket dissection, and careful implant handling, reduce inflammation and potential bacterial introduction. Patients who undergo radiation therapy, often for breast cancer, face an elevated risk due to radiation’s effect on tissue integrity and healing.
Recognizing and Diagnosing Capsular Contracture
Capsular contracture is recognized by noticeable changes in the breast’s feel and appearance. Symptoms include increased firmness or hardness of the affected breast, ranging from mild to significant. Pain or tenderness is common, especially in advanced cases. Visible distortion, unnatural rounding, or implant displacement are also indicators. The implant might feel unnaturally high or out of place.
Diagnosis of capsular contracture is primarily based on a thorough clinical examination performed by a plastic surgeon. The surgeon will physically assess the breast for firmness, shape changes, and tenderness, often using the Baker grading system to classify the severity. While physical examination is the main diagnostic tool, imaging studies may be used to rule out other potential issues or to confirm the integrity of the breast implant. An ultrasound or MRI can visualize the implant and surrounding tissues, differentiate between contracture and other complications like implant rupture, or identify fluid collections.
Treatment and Management Options
Management of capsular contracture depends on its severity and patient symptoms. For milder cases, non-surgical approaches are explored, though their effectiveness for established contracture is limited. These measures include massage techniques to soften the capsule or medications like anti-inflammatory drugs or leukotriene inhibitors to reduce inflammation. These approaches offer temporary or minimal relief and are not curative for moderate to severe contracture.
Surgical intervention is the most common and effective treatment for symptomatic or advanced contracture. Several surgical procedures can address the condition, with the choice depending on individual circumstances and surgeon assessment. A capsulectomy involves complete removal of the scar tissue capsule, often considered for more severe cases. A capsulotomy involves making incisions or scoring the capsule to release tension, allowing the implant to expand into a more natural shape.
Implant exchange is frequently performed during surgical correction, replacing the existing implant, sometimes with a different type, size, or surface texture. Surgeons may also perform a pocket change, repositioning the implant from one plane to another, such as subglandular (above the muscle) to submuscular (below the muscle). This change can reduce recurrence by providing a new, less reactive environment for the implant.