Capsular Contracture and Breast Implants

Causes, Prevention, and Treatment

In This Article

Capsular contracture is a common complication of breast implant surgery that affects up to 30% who have augmentation or reconstruction. A breast should be soft, flexible, and drape naturally, even if it is a reconstructed breast that was surgically created after a mastectomy. If you have saline or silicone breast implants, capsular contracture can cause your reconstructed breast to shift, change shape, or feel quite hard.

If this happens in your case, you can get treatment to correct the problem. Both non-surgical and surgical options are available, and the best option depends on the severity of the contracture as well as personal preference. That said, prevention is the best "cure" and there are several things you can do yourself to lower your risk of developing a capsular contracture—both initially, and a recurrence if you should require surgery to correct the problem.

Overview

Your body is smart—your immune system knows when a foreign object has been put into your tissues. When an intruder (such as a breast implant) is detected, a periprosthetic capsule is formed around it.

Think of it this way: Your chest muscles and skin don't readily accept an implant as a natural part of your breast. In order to isolate the implant and keep it from growing, spreading, or wandering around, your body creates a sac, or capsule of scar tissue around it, to seal it off.

A capsule around a breast implant is a naturally occurring tissue that can be of benefit. If that capsule contracts or thickens, however, it can squeeze your implant. This contracture is what will cause pain, shifting, distortion, and hardening of the reconstructed breast.

Possible Causes

Capsular contracture can happen any type after a breast implant is placed in your breast. It occurs more often around silicone than saline implants, and appears to be more common when implants with textured surfaces are used. (Due to a very small risk of developing angiosarcoma of the breast, breast surgeons are now leaning away from textured implants.)

Sometimes it develops due to an infection that sneaks in during implant surgery. But other problems may also crop up, like a seroma (a pocket of blood serum within the surgical area) or a hematoma (a pool of blood below the skin). These may also contribute to the development of capsular contracture.

The longer an implant is in place, the greater the chance that a contracture will develop.

Diagnosis

The diagnosis of capsular contracture and the severity when present can often be estimated based on a physical exam alone. Imaging studies can offer further insight, with magnetic resonance imaging (MRI) being the most accurate test in making the diagnosis.

Baker Scale Grade

Capsular contracture may be barely noticeable, or severe enough to greatly impact your quality of life. Capsular contracture is graded by the Baker scale and follows these criteria:

  • Grade I: The breast is soft and appears normal, and the capsule is flexible
  • Grade II: The breast looks normal, but is somewhat hard to the touch
  • Grade III: The breast is hard and has some distortion caused by contracture, or instead, the breast may be significantly distorted and either have a rounded shape or have the implant tilted upwards
  • Grade IV: Grade IV contractures look similar to grade III, but involve greater hardening of the capsule

Treatments

If you develop stiff tissue around a breast implant, if the shape distorts, or if the implant wanders out of position, you can get help. A capsulectomy is surgery that removes the stiffened capsule, and the implant may be replaced during this procedure for best results.

A capsulotomy is surgery to loosen the scar tissue by slicing it, which allows for expansion.

Fat grafting has been a relatively recent addition to reconstruction options, and has been used primarily to improve the cosmetic appearance and feel of the breast post reconstruction. A small 2019 study (15 patients with Baker grade IV contractures) looked at the potential role of fat grafting in capsular contracture. The researchers found that fat grafting was very successful in relieving the pain due to contracture, and suggested that fat grafting may be a useful addition to treatments currently available for contracture.

Surgery may not always be needed, however, as conservative methods such as massage, ultrasound, and medications may help the stiff capsule relax.

Talk to your doctor about your options and the advantages and disadvantages so you can make an educated decision on the treatment that is right for you as an individual.

Prevention

You and your surgeon can work together to try and prevent the development of a stiff capsule of tissue around your breast implant.

Your Surgeons Role in Prevention

There has been a significant amount of research lately into methods of reducing or preventing capsular contracture from occurring. Some surgeons prescribe preoperative medications such as prednisone or vitamin E, but others have not found this to be effective.

The placement of implants is also being evaluated relative to the tendency to develop contractures. Implants can be located beneath the mammary gland or within a muscle pocket, and those placed within muscle appear to be less likely to develop capsular contracture. Your surgeon may use Alloderm (a piece of human tissue but which lacks DNA) to line the muscle pocket to further reduce the likelihood of scar tissue build-up around your implant.

What You Can Do

If you have surgical drains to maintain after breast surgery, be sure to empty these on schedule, as this helps prevent seromas from developing. Some surgeons recommend performing post-operative massage on the reconstructed breast, though studies thus far don't seem to find that massage is effective in reducing capsular contracture and massaging your breast after surgery can be uncomfortable.

Recovery From Breast Surgery

There are a few things that you should avoid after breast implant surgery to ensure a healthy recovery, and minimize your risk of developing a contracture.

  • Quit smoking before surgery: Smoking either before, during, or after your surgery increases your risk of both a capsular contracture and an infection. It will also delay healing and your recovery from surgery, and increases the risk of complications such as blood clots. (These are only a few of the reasons why it's important to quit smoking after a cancer diagnosis.)
  • Avoid being overly active: Take it easy doing physical activities and avoid activities that might cause injury to the newly reconstructed breast. The implant needs time to settle into place, so don't jostle, squeeze, or strike the surgical site at all. It's worth taking the time to ask your plastic surgeon specific questions about your activity level after surgery, as some activities that seem benign may be of concern, while others that you might think you should avoid are OK.
  • Have a careful careful conversation with your surgeon if you will be having radiation: If you know that you'll be having chest wall radiation after your mastectomy, consider delaying implant surgery until treatments are completed. According to a 2018 study, radiation following immediate construction is associated with a significantly greater risk of reconstructive failure as well as complications such as infections, and capsular contracture. Treatment of these complications can be lengthy and challenging, so it may very well be worth your time to delay reconstruction until your radiation is completed and you are fully healed. That said, many people wish to pursue immediate reconstruction despite this risk (as a way to begin normalizing their life), and this is very understandable. if you choose to do so, have an in-depth discussion with your surgeon about what you might expect so that you can weigh your options carefully. As with many aspects of cancer care, some people find it helpful to make this objective by writing out a pros and cons list.

Take the time to ask your surgeon about ways to reduce capsular contracture. Many studies are in progress, and your surgeon will likely be aware of the latest research on ways to lower your risk.

A Word From Verywell

Capsular contracture related to breast implants can be very uncomfortable and lower your quality of life. Certainly there are treatments that can help, but it's ideal to reduce your chance of this occurring in the first place. Talk to your surgeon about what she recommends on her part, and the rationale behind her practice. Make sure to be aware of and heed those factors that you can control. Fortunately, with newer approaches such as the use of Alloderm, the chance that you will experience capsular contracture is lower than in the past.

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Article Sources

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  1. Papadopoulos S, Vidovic G, Neid M, Abdallah A. Using Fat Grafting to Treat Breast Implant Capsular Contracture. Plastic and Reconstructive Surgery. Global Open. 2019. 6(11):e1969. doi:10.1097/GOX.0000000000001969

  2. Pu, Y., Mao, T., Zhang, Y. et al. The Role of Postmastectomy Radiation Therapy in Patients With Immediate Prosthetic Breast Reconstruction: A Meta-Analysis. Medicine (Baltimore). 2018. 97(6):e9548. doi:10.1097/MD.0000000000009548

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