Capsular Contracture

All surgeries have risks, and breast augmentation is no exception. Capsular contracture occurs when scar tissue forms around the implant, resulting in painful breast stiffness and possible leakage of the fluid inside the implant.

Women often fear this common complication because it is difficult to predict when it will occur and who will develop it. Most women start having symptoms around three months after their breast implant surgery, but you can develop capsular contracture at any time, and it can recur after it is treated.

Capsular Contracture:

Almost every woman with breast implants has scar tissue surrounding her implants. This scar capsule doesn’t show -- it’s inside her breast, and is her body’s natural way of protecting her from a foreign object. Sometimes, however, that capsule is too tight for the implant. Capsular contracture is when the capsule is too tight and feels like it is squeezing the implant.

• It can happen with either saline or silicone gel breast implants
• It can be slightly uncomfortable or very painful
• It can change the shape of your breast, or make it look round and unnatural
• You may need surgery to fix it
• Once it is surgically fixed, it is likely to happen again

This condition will not usually get better by itself. If it is very painful or hard, it will require surgery to remove the scar tissue capsule and perhaps the implant. Some of your own breast tissue might get mixed in with the capsule, and you might lose some of your natural breast. Many insurance companies will pay to have your implant removed if a woman has Baker Grade III or IV contracture, which are the most severe types, because when implants are that hard they are especially likely to interfere with mammography and the detection of breast cancer.

Capsular Contracture: Are You at Risk?

Capsular contracture occurs in about 5 percent of women, and while there is no way of telling who is going to develop it, several factors may increase your risk. They include:

• Autoimmune disorders
• Smoking
• Radiation therapy
• Severe trauma to the breast
• Hematoma (a break in blood vessel, causing localized bruising or blood clot)
• Seroma (a collection of fluid under the skin)
• Bacterial infections
• Silicone molecules leaching into the pocket surrounding the implant
•  Breast implant placement. You may be more likely to develop capsular contracture when your implants are placed over your chest muscle (subglandular)

Capsular Contracture: Decreasing Your Risk

Some surgeons believe that placing the breast implant under your pectoral muscles significantly lowers your chance of developing contracture because of the constant massage that the implant receives from the muscles.

Other ways to decrease your risk for capsular contraction may include:

• Taking a prescription corticosteroid drug called prednisone for two weeks.
• Massaging your implants the day after surgery.
• Performing compression exercises in which you squeeze the implant with medium pressure to keep the capsule flexible and loose.

Ask your breast surgeon for specific advice on how to decrease your risk for capsular contracture.

Symptoms of Capsular Contracture

Capsular contractures range in severity from mild annoyance to devastating deformity. When the capsule tightens and hardens, you may experience any or all of the following symptoms:

• hardening of the breast
• pain in the breast
• asymmetry of the breasts
• painful deformity of the breast

Doctors grade contractures on the Baker Classification Scale as below:

* Grade I – No capsular contracture.
* Grade II – Mild capsular contracture. Slight firmness.
* Grade III – Moderate capsular contracture. Firmness with visualization of the implant, may appear unnaturally round or misshapen.
* Grade IV – Severe capsular contracture. Hard and deformed breast with hardened visible scar tissue and pain.

Treating Capsular Contracture:

In the past, the only remedy for capsular contracture was removing the implant and the residual scar tissue, but times are changing. Today, there are treatments for severe capsular contracture. Some surgeons may squeeze your breast and implant to break up the capsule. This can be painful, and may cause implant deflation or bleeding.

Other surgeons prefer to surgically lance the contracted tissue surrounding the implant to loosen it and break it apart. Additional treatments may include steroid injections and vitamin E.

New technologies are being developed to treat capsular contracture, including the use of sound waves to soften the breasts. However, even if your symptoms are effectively treated, it is possible to develop capsular contracture again.