A breast implant capsule is a natural physiological reaction to a foreign object. It is a thin, fibrous layer of scar tissue the body forms around any implant, including breast implants. This tissue is composed primarily of collagen fibers, which the immune system deposits to create a barrier and wall off the implant from the surrounding breast tissue.
The Body’s Natural Response to Implants
The process of capsule formation is known as the foreign body response, initiated by the immune system recognizing the implant as non-self material. Specialized immune cells respond to the implant surface, triggering fibroblasts to lay down a sheet of collagen that solidifies into the capsule. This biological enclosure stabilizes the implant, keeping it in its intended pocket and providing a protective shield.
A normal, healthy breast implant capsule is soft, thin, and pliable, often remaining undetectable to the touch and having no effect on the breast’s appearance. The characteristics of this initial capsule are influenced by factors related to the implant and surgical technique. For instance, implants placed under the chest muscle often develop a thinner, more adherent capsule compared to those placed above the muscle. The surface texture of the implant—smooth versus textured—can also affect the capsule’s formation, with some surface types designed to encourage a more compliant scar layer.
Understanding Capsular Contracture
Capsular contracture represents an abnormal hardening of this normally soft scar tissue layer. This condition occurs when the collagen fibers within the capsule thicken, tighten, and shrink around the implant, creating an internal squeeze. The resulting pressure can cause the breast to feel firm, distort its shape, and potentially lead to chronic pain.
The exact cause of capsular contracture is not fully understood, but it is often linked to chronic, low-grade inflammation. Factors that increase this inflammatory response, such as a microscopic layer of bacteria on the implant surface called a biofilm, contribute significantly to the condition. Other influences include a pocket of blood (hematoma) or fluid (seroma) forming shortly after surgery, implant rupture, or genetic predisposition for excessive scarring.
To classify the severity of the hardening, healthcare providers use the Baker Grading System, which divides capsular contracture into four distinct grades. Grade I is the ideal state, where the breast is soft and looks completely natural. Grade II indicates a slightly firm breast that retains a normal appearance, noticeable only upon physical examination. Grade III involves a breast that is firm to the touch and shows visible signs of distortion or an unnatural appearance. Grade IV is the most severe classification, characterized by a hard, severely misshapen breast, frequently accompanied by tenderness or chronic pain.
Addressing Severe Capsule Formation
Treatment for capsular contracture is reserved for advanced stages (Baker Grade III and Grade IV), where symptoms affect both breast appearance and comfort. Non-surgical approaches, such as specialized massage or anti-inflammatory medications, are sometimes attempted for milder cases, but their effectiveness in resolving severe contracture is limited. For clinically significant hardening, surgical intervention is required.
Two primary surgical options exist for addressing the problematic capsule. A capsulotomy involves making controlled cuts into the hardened capsule to release the tension and allow the implant to decompress and reposition naturally. The more definitive solution is a capsulectomy, which involves the complete removal of the entire scar tissue capsule.
In some cases, a total capsulectomy is performed, where the capsule is removed in sections, followed by the implant. An en bloc capsulectomy is a specialized technique where the surgeon removes the implant and the surrounding capsule as a single, intact unit. The choice between capsulotomy and capsulectomy depends on the capsule’s thickness, the severity of the contracture, and whether an implant rupture is suspected.
Following either procedure, the existing implant is often removed and may be replaced with a new one, or the patient may choose to forgo re-implantation entirely. Implant replacement, often with a change in the implant type or pocket location, is done to reduce the risk of recurrence.