Capsular Contracture
Capsular contracture is the most common long-term complication of breast implant reconstruction surgery. It can also develop in people who got breast implants for cosmetic augmentation.
Capsular contracture occurs when the scar tissue around a breast implant becomes too tight and firm. The implant gets compressed, causing symptoms like pain, tightness, and changes in the shape and position of the breast.
Normally, once a breast implant is in place, scar tissue forms around it, creating a tissue capsule. The body forms a protective capsule around any object it recognizes as foreign. The tissue capsule is usually soft or slightly firm, not noticeable, and helps to keep the implant in place. But in people who develop capsular contracture, the scar tissue capsule is unusually tight or hard and dense.
In the past, some people who developed capsular contracture didn’t necessarily know what was causing their symptoms or that the condition could be corrected, and they lived with chronic pain from their implants or distortion in the appearance of the breasts. But there are procedures available to correct capsular contracture — and in many cases they’re covered by insurance.
Capsular contracture symptoms and signs
Symptoms of capsular contracture can start to appear as early as a few months after breast implant reconstruction surgery or years afterward.
In people who have implants in both breasts, capsular contracture might affect one or both implants.
Capsular contracture symptoms can include:
increasing firmness or tightness in the breast
pain in the breast, that can range from mild to severe
changes in the shape and appearance of the breast, such as the breast moving higher on the chest and/or looking distorted
the breasts becoming uneven (asymmetrical)
restricted movement of the breasts and the chest
If you’ve had breast implant surgery and you develop symptoms of capsular contracture that are bothering you, it’s important to tell your plastic surgeon.
Doctors use a grading system (called Baker grades) to describe the severity of capsular contracture. Grade II describes minor symptoms, grade III is for moderate symptoms, and grade IV, for severe symptoms.
Who’s at risk for capsular contracture?
Researchers and doctors aren’t sure why capsular contracture happens, but they do know of some factors that can raise the risk.
If you’ve had radiation therapy at any time in the past — and particularly if you had it after you had the tissue expander or implant placed — it can greatly raise your risk of developing capsular contracture.
Some other factors that may increase the risk of developing capsular contracture include:
a genetic predisposition to forming scars (some people may have certain genes linked to forming more significant scarring after a surgery or injury)
biofilm (a thin layer of bacteria, often staph bacteria) forming on the surface the implant and causing inflammation
bleeding around the tissue expander or implant (also called hematoma) or a buildup of fluid where tissue was removed during surgery (called seroma)
a personal or family history of autoimmune disease
Also, when the breast implant is placed on top of the chest muscle (this is called prepectoral placement), there’s a slightly higher risk of developing capsular contracture compared to when it’s placed under the chest muscle (subpectoral placement).
But overall, the reasons that some people develop capsular contracture while others do not are not well understood.
Capsular contracture treatments
There are several surgical options for treating capsular contracture. Many but not all health insurance plans in the U.S. cover procedures to correct capsular contracture that occurred after breast reconstruction surgery. Your plastic surgeon will probably need to provide documentation to the insurance company that the procedure is medically necessary and not just cosmetic.
Options that allow you to continue to have implants
The following surgeries may correct capsular contracture, but there’s a risk that it could happen again if your body continues to react to breast implants in the same way.
Capsulectomy
During a capsulectomy, the surgeon removes the existing breast implant and the surrounding tissue capsule. The surgeon may insert a new implant and may wrap it in a sheet of dermal matrix material (a soft tissue substitute made mostly of collagen). The dermal matrix material provides an extra protective layer. Your body forms a new capsule of scar tissue around it.
Open capsulotomy
During an open capsulotomy, the surgeon attempts to release the tight tissue capsule around the breast implant by making incisions in the capsule. The surgeon may also remove some of the capsule. The goal is for the capsule to pop open, giving the implant more room to move around. In some cases, the surgeon might also remove your existing implant and replace it with a new one.
Other options
These surgeries involve permanently removing the breast implants (and not replacing them), which can greatly reduce the risk of capsular contracture happening again.
Aesthetic flat closure
The surgeon removes the breast implant and surrounding tissue capsule and then performs an aesthetic flat closure procedure (also known as going flat). The surgeon removes any extra skin in the breast area and then tightens and smooths out the remaining tissue to create a flat chest wall contour. The breast mound is not reconstructed.
Flap reconstruction surgery
The surgeon removes the breast implant and surrounding tissue capsule and then does a flap reconstruction procedure. This involves reconstructing the breast with a flap of tissue transferred from another area of your body, such as your lower belly or buttocks. It reduces or eliminates the risk of capsular contracture happening again because tissue capsules are less likely to form around flaps. However, flap reconstruction is a more complex surgery with a longer recovery time, compared with the other procedures that can potentially help correct capsular contracture.
This information made possible in part through the generous support of www.BreastCenter.com.