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As a natural reaction to any device placed in the body, scar tissue will form around the breast implant surface creating a capsule |
What is capsular contracture?
Capsule contracture is one of the most common complications of breast augmentation surgery and occurs in up to 15% of patients by the 6th year after surgery according to data from Mentor and Allergan. It usually occurs within months of the procedure but may occur at any time. After breast augmentation surgery, a natural response from your body is to form a lining or “capsule” around the implant. This happens when foreign objects are placed into the body, for example, pacemakers or artificial joints. During the healing process, the capsule forms and most of the time it stays soft and pliable giving the breast implant a natural look and feel.
In some cases, the capsule will squeeze and tighten the implant giving it a hard, ball-like look.The implant has not hardened but is being compressed by the thickened capsule. When the capsule is removed the implant will still be as soft as it was the day that it was inserted.
What causes capsular contracture?
The causes of capsular contracture is not exactly clear. There are some factors that can increase your likelihood that you will experience capsular contracture:
- Germ contamination (Having dental work done right after surgery or infection in the breast or elsewhere in body)
- Subglandular placement. Breast implants placed above the muscle tend to have higher contracture rates than implants placed below the muscle.
- If you have had a Seroma or Hematoma right after surgery
- Smoking. If you are a smoker, the healing process could be delayed by a decreases in oxygen levels.
- Autoimmune disorder
There are different degrees of capsular contracture. The Baker Grading System categorizes four grades of capsule contracture.
Baker Grade I : The breast is normally soft, and looks natural. Most women following breast augmentation have this because we all have a capsule. It is only when the capsule starts to thicken that the capsule contracture occurs.
Baker Grade II: The breast is a little firm, but appears natural.
Baker Grade III: The breast is firm and is beginning to appear distorted in shape.
Baker Grade IV: The breast is hard and has become quite distorted in shape. There may also be some pain or discomfort associated with this level.
Treatment of Grade I-II capsular contracture is often with adjunctive therapies such as massage, ultrasound, Vitamin E and with newer drugs such Accolate, a drug used in the treatment of Asthma. Accolate is usually given at a dose of 20 milligrams twice daily and may take several months before results are seen
The most effective treatment of Grade III-IV capsular contracture is to remove the whole capsule (capsulectomy). Just scoring the capsule (capsulotomy) usually is ineffective. Other procedures such as closed capsulotomy in which the breast is squeezed until the capsule is broken is not recommended as it may cause implant rupture and in fact voids the implant warranty. Our usual procedure for subglandular capsular contracture is to remove the entire capsule and perform a submuscular conversion. For submuscular capsular contracture we will perform a capsulectomy. Operative times vary but usually are 1½ hours per side. Recovery is similar to a primary augmentation. Postoperatively, massage, Vitamin E and Accolate are often given to prevent recurrent contracture.
Calcified capsule and ruptured silicone implant
It is very common for other problems such as ruptured silicone implants or shape or positional problems to occur with capsular contracture. In fact, we consider old hard silicone implants to be ruptured until proven otherwise. Many times a mastopexy (breast lift) is needed along with capsulectomy for droopier hard breasts.
Old silicone implants and capsular contracture.
All breast revision procedures are performed in Sanctuary Plastic Surgery’s class C AAAASF operating suite in Boca Raton.
Breast implant revisions performed by Dr. Jason Pozner.
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How to Prevent Capsular Contracture
There are no sure fire ways to prevent capsular contracture. You are more likely to get capsular contracture if your implants are placed above the muscle. Therefore, placing the implant underneath the muscle can decrease your chances. The constant massage that the breasts receive from the muscles helps prevents capsular contracture.
Prevention of Capsular Contracture through Breast Massage
Following breast surgery, the medical assistant will instruct you how to perform breast exercises. Do these massages twice a day. The purpose of these exercises is to keep the pocket open and the capsule loose and elastic.
Step One: Put your thumb in the armpit, fan your fingers open across the top portion of the breast, bring your thumb to the index finger, keeping your palm flat to the breast giving a squeeze moving implant down (south).
Step Two: Take your pinky finger, put it underneath the fold of the breast. Slowly rotate your hand upward, keeping areola and nipple complex between thumb and index finger. Hold for ten to fifteen seconds. Slowly open you hand and allow the implant to come into the palm of your hand.
Step Three: Place the palm of your hand on the outer portion of the breasts. Slowly push inward. Hold ten to fifteen seconds. Slowly release.
Step four: Opposite hand, opposite breast. Hold your hand open, with the thumb in the middle of the breast, Slowly push outward towards the armpit. Hold fifteen seconds. Repeat other side.
Do these exercises for five minutes in the morning and five minutes in the evening. You will complete them in about four to five minutes.
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