Capsular Contracture

Capsular Contracture

The photograph shows capsular contracture in the right breast of a 29 year old woman. The 560cc silicone gel implants are subglandular and the capsular contracture is grade IV.

What is Capsular Contracture?

As part of its immune system, the human body encapsulates any foreign object in a fibrous capsule. This will happen naturally with your breast implants. In most cases, the capsule will stay soft and won't be noticeable. Your breasts will feel natural to your touch and perhaps more importantly, they will also look natural. Unfortunately, in some women, the capsule tightens and contracts; so much so, that it becomes hard. This condition is called capsular contracture. When it happens, the symptoms usually include discomfort and sometimes pain. Your breasts may feel quite hard and different to their normal and natural soft touch. Additionally, their shape may change and the breasts may not have a normal appearance to how they are situated. In some patients, depending upon the severity of contracture, the breast implant will need to be replaced. This will involve a new surgical procedure which is more complicated than simple breast augmentation. However, in less sever cases, a simple firm massage may resolve the problem.

The risk of Capsular Contracture

Capsular contracture is the most common cause of further surgery being required following breast augmentation but it is rare. Patients who smoke and those who experience complications such as an infection following breast enlargement surgery are at a higher risk of developing capsular contracture. Also patients choosing to have the sub glandular implant placement (overs) are at a higher risk.

It is reported that the introduction of textured breast implants has served to reduce the risk of acute capsular contracture.

Severity Levels (Grades) of Capsular Contracture

Capsular contracture will always occur. It just depends as to what extent or severity. In the vast majority of cases, it does not affect the feel or appearance of the breasts. There are 4 different grades of severity of capsular contracture:

I The breasts still appear to look natural and they feel soft.
II Some firmness in the breasts can be felt but they still appear natural.
III The breasts feel very firm and they appear peculiar.
IV The feel hard to the touch. They appear abnormal and cause discomfort or pain.

Treatment of Capsular Contracture

The extent of the capsular contracture will determine which procedure the surgeon will choose to correct the issue. There are two main treatments:

  • Closed Capsulotomy
    This procedure is non invasive/non surgical. The breast with the contracture is hand squeezed with the aim of trying to tear the fibrous capsule around the implant. This procedure can be very effective because if it is successful, it can provide immediate relief for the patient.

    If the fibrous capsule is too tough and resistant to closed capsulotomy, the procedure will not be successful and an alternative treatment will be required. In addition, there is a risk that of breast implant rupture when using this technique, particularly with saline implants. Such an implant rupture would then require surgery in order to remove the ruptured implant and capsule and replace it with a new implant.

  • Open Capsulectomy
    This procedure requires surgery. It is considered to be of lower risk than the closed technique but it is invasive. The surgeon makes an incision which will allow access to the fibrous capsule around the implant. Further incisions are then made into the capsule to release the tension caused by its contraction. The implant may also be completely removed and then reinserted before completion of the procedure. In some cases the implant will be replaced. Day release (i.e. no overnight stay in hospital) is not usually available with this option.