What Is Capsular Contracture And How Can It Be Treated?
If your breast implant feels firm, aches, or appears deformed, you could be suffering from capsular contracture.
Capsular contracture occurs when the fibrous scar tissue (the capsule) that usually forms around the implant becomes contracted and compresses the implant. This can produce discomfort and change the appearance of the breast.
Capsular contracture may be treated conservatively with non-surgical methods or surgically through a corrective operation based on the degree of contraction.
We’ll go over what to look for in terms of signs, who’s at risk, the various non-surgical and surgical treatment options available, and how to minimize and treat the recovery and potential prevention of this issue to develop a solid plan with Dr. David A. Newman and our staff.
If you think you may have capsular contracture and are in the Temecula area, contact Newman Plastic Surgery for a case consultation.
What is Capsular Contracture?
Capsular contracture is when the fibrous scar tissue surrounding a breast implant (capsule) becomes contracted and compresses the implant. Normally, your body forms a thin layer of fibrous scar tissue called a capsule to encapsulate any foreign object, including a breast implant. However, when the capsule becomes thickened and contracts, it can cause discomfort and change the appearance of the breast. You may notice that one breast is firmer than previously or that both are uneven. Firmness can vary from a mild tightness to a completely firm, misshapen breast. Discomfort or pain may occur due to the tight capsule.
Capsular contracture can alter the implant position, shape, and the overall appearance of the breast.
How Does Capsular Contracture Occur and Why?
Capsular contracture begins with inflammation around the implant. The most common causes of inflammation are contamination by bacteria that occurred either during or after surgery, postoperative bleeding, or minor repeated injuries to the area. The body reacts by creating more fibrous scar tissue, and, in some cases, contracting it.
Risk factors for developing capsular contracture include:
- Implants placed above the muscle
- Smooth-surface implants
- Smoking
- Radiation therapy to the chest
- Infection
Infection is the primary cause. Even small levels of bacteria can continue to inflame the area chronically. An individual’s healing response plays a role in their ability to form thickened scars.
Symptoms to Look Out For
Watch for changes in firmness, shape, and pain. Mild contracture may present itself as a slight, early tightening or change in the breast shape. Severe contracture may cause the breasts to appear rounded, higher, or unbalanced.
Some common symptoms include:
- Increasing firmness or hardness of the breast
- Visible changes or irregularities in the shape of the breast
- Pain, tenderness, or discomfort, especially with compression
- The implant feels higher or pushed towards the middle of the breast
If you experience persistent firmness, worsening symmetry, or pain, schedule an appointment with our office immediately. Identifying symptoms earlier in the process allows for greater options in treatment and helps prevent further progression.
Risk Factors for Developing Capsular Contracture
Some of the risks for developing capsular contracture include medical histories, types of implants, and individual healing responses.
Smoking, radiation therapy, contamination of the implant with bacteria, the type of implant, and the location of the implant all contribute to the development of capsular contracture.
Common Risk Factors
Radiation therapy to the chest can damage tissues and stimulate chronic inflammation around the implant. Smoking also restricts blood flow and slows down the healing process, which promotes scarring.
Even tiny amounts of bacteria on the implant can start a cycle of chronic inflammation. Bacteria can grow in the initial fluid or blood that develops around the implant in the early post-operative period. If you are prone to repeated infections or have a tendency to form dense scars, you are at increased risk of developing contracture.
Implant Surface Types Matter
Smooth-surface implants pose a different level of risk than textured implants. Larger implants or those positioned directly under the muscle (subglandular) can exert greater pressure on the capsule and increase the likelihood of it becoming contracted.
How Surgeon Techniques Influence Risk
Your surgeon’s techniques affect the prevention of infection and tissue trauma. Maintaining strict sterility, gently managing the implant, and limiting the amount of time spent in the operating room can significantly reduce the amount of bacteria transferred to the implant and subsequently reduce the risk of developing contracture.
The placement of the implant also influences the risk of developing contracture. Generally, the submuscular (under the pectoralis muscle) placement of the implant reduces the risk of contracture compared to subglandular placement. The muscle provides additional protection and reduces direct pressure on the capsule.
Additional Choices That Influence Risk Include:
Incision Site – Whether a sleeve or irrigation solution was used during the implantation process
Gentle tissue dissection, controlling hemorrhage to minimize the amount of bleeding around the implant, and the use of an antimicrobial wash can all reduce the number of triggers that can lead to contracture.
Treatment Options for Capsular Contracture
Both non-surgical and surgical methods exist for treating capsular contracture. Both options are designed to alleviate pain, soften the breast, and restore its original shape. Depending on the degree of the symptoms, Baker Grade, and personal preferences, you can select one method or combine both.
Conservative Measures
Conservative measures can be effective in treating mild to moderate cases of contracture and may delay the necessity for surgery. Medications such as anti-inflammatory agents can provide relief from pain and swelling. Other non-surgical methods include targeted massage and ultrasound therapy to soften the capsule. While massage and ultrasound may be beneficial when implemented early, they can rarely reverse firm, advanced contractures. Some clinics provide device-based treatments (such as external ultrasound or massage devices) to reduce the tightness of the capsule; anticipate moderate success and possible repeat sessions.
Provide your surgeon with information regarding any signs of infection. If a cause such as a low-grade infection or seroma is detected, antibiotics or drainage may be necessary prior to initiating any other treatments.
Surgical Alternatives
Surgery is the most reliable method to correct moderate to severe contracture or when symptoms do not improve. Commonly performed surgical alternatives for correcting contracture include:
Capsulotomy – the surgeon opens and cuts into the capsule to release the tension.
Capsulectomy – partial or complete removal of the scar tissue that has become hardened.
Exchange of Implant – replacement of the current implant, commonly with an alternative type or positioning.
Based upon your case, your surgeon may elect to move the implant pocket from subglandular to submuscular, utilize textured or smooth-surfaced implants, or apply an acellular dermal matrix to minimize recurrence. Surgery, however, carries risks including bleeding, infection, anesthetic complications, and recurrence of contracture. Recovery and follow-up appointments are generally required and vary, but typically include restrictions on activity and follow-up appointments to assess healing.
Determining Which Treatment Option Works Best for You
Determine your treatment options based upon your symptoms, the age of your implant(s), and your cosmetic objectives. Non-surgical methods may be considered reasonable to attempt initially if your breast feels only slightly firmer and/or you experience minimal pain. If you suffer from pain, noticeable distortion, or a Baker Grade III-IV contracture, surgery will likely provide the most favorable long term results.
Consult with Dr. David A. Newman at our clinic to determine specifics including expected outcomes, the location of your scars, implant options, and the risk of recurrence. Ask about utilizing imaging (MRI or ultrasound) to assess the integrity of the implant(s) and to determine if any infection or rupture is occurring. Create a written plan outlining the procedural steps, anticipated recovery timeline, and follow-up care to ensure you understand what to expect.
Recovery and Prevention
Recovery from surgery is generally brief, followed by a series of strategies to minimize the risk of recurrence of capsular contracture. Expect to follow a regimen of wound care, limited activity, and follow-up appointments to identify any problems early-on and protect your results.
Post-Surgical Care
Following surgery, you will have dressings and possibly drains that are removed within 24-48 hours. You may experience a period of tightness, bruising, and soreness that reaches its peak in the first week and continues to improve until two to six weeks post-operatively.
Your surgeon will provide you with a specific timeline: when to remove your dressings, when to remove your drain(s) (if applicable), and when to return for suture removal and examinations.
Activity Restrictions
Limiting your physical activity is important. For four to six weeks post-operatively, avoid heavy lifting, bending, or any exercise that strains the chest muscles. Gradually return to normal activities as directed by your surgeon. Wear the recommended post-operative supportive garments or bras to control swelling and support the implant position.
Be aware of warning signs that require immediate attention from the office: increasing pain, redness, fever, sudden firmness of the breast, or unusual drainage. Contact the office as soon as you experience any of these symptoms. Prompt treatment will decrease the risk of complications and may reduce the need for future surgery.
Ways to Decrease the Likelihood of Reoccurrence
Adhere strictly to the instructions provided for preventing infection: take any antibiotics that were prescribed, maintain the cleanliness and dryness of your incisions, and refrain from touching the areas with unwashed hands. Infection and chronic inflammation are major contributors to the risk of developing contracture.
Avoid smoking and the use of nicotine products for at least four-six weeks pre-operatively and post-operatively. Nicotine can slow the healing process and promote scarring.
Attend all scheduled follow-up appointments to allow Dr. David A. Newman to evaluate the formation of the capsule early. If Dr. Newman identifies any evidence of early tightening, non-surgical interventions such as massage (as directed), ultrasound, or medications may be effective.
During breast implant revision surgery, the choices that can minimize recurrence include capsulectomy or capsulotomy, converting the implant pocket from subglandular to submuscular, using textured or smooth-surfaced implants selectively, and applying an acellular dermal matrix. Discuss the risks and benefits with the staff to develop a plan tailored to your specific situation.