Capsular Contracture

Capsular contracture is a common complication that occurs with breast augmentation. This develops when the internal scar tissue tightens and constricts the capsule around the breast implant and contracts it until it becomes misshapen and hard. This results in the painful and stiff breast.

Studies suggest that cases of capsular contracture are lower with saline implants than with silicone gel implants. Symptoms of capsular contracture may occur within a few months of the surgery. About 75% of capsular contracture cases occur within two years post-op. If the capsular contracture occurs many years after the surgery, especially in cases of silicone gel implant, it could be a sign of an implant rupture.

According to Baker grading system, there are four grades of capsular contracture:

• Grade I, where the breast is soft and looks natural.
• Grade II, where the breast is slightly firm but looks normal.
• Grade III, where the breast is firm and looks abnormal.
• Grade IV, where the breast is hard, painful and looks abnormal.

Studies also suggest that capsular contracture occurs in about less than 5% of women who undergo breast augmentation with implants. The most common cause of capsular contracture is due to the infection caused by a microorganism present at the site. Whenever there are microorganisms, chances of infection or biofilm formation is high which could lead to capsular contracture.

It is an infection caused by a bacteria that can wall itself off and the body can’t fight it and when the body tries to fight it the scar tissue gets more and more active and capsular contracture tightens.

For surgery, the surgeon will prepare your skin by giving antiseptics and antibiotics but it cannot lower the bacterial count to zero. So the main strategy is to work out the contracture wall with a comprehensive approach to keep the bacteria away from the implant before, during and after the surgery.

Here is what a good surgeon will do to lower the chances of capsular contracture:

• Prescribe antibiotics before the surgery
• Avoid Periareolar incision. A study shows a higher risk of capsular contracture when the incision is made around the areola. Some studies also concluded that Transaxillary incision may also cause capsular contracture. This is due to the bacteria in the nipple ducts that can potentially contaminate the implant. Hence in most cases, the infra-mammary incision is preferred, so the implant can be placed under the muscle.
• Nipple ducts harbour bacteria, hence a plastic patch or nipple shield can be used during the surgery to shield the surgical field from the bacteria source.
• A good surgeon will also take extra precautions by washing the pocket where the implant is going to be placed with a triple antibiotic mixture.
• A good surgeon will also change their surgical gloves just before the placement of the implant and place a plastic barrier that is temporary over the skin so that the implant doesn’t touch the skin while being placed.

Other factors that may increase the risk of developing capsular contracture include:

• Postsurgical complications like:
  • Hematoma (broken blood vessels under the skin),
  • Seroma (collection of fluid under the skin) and
  • Bacterial infection
• Autoimmune disorders, like lupus
• Severe breast trauma
• Radiation therapy
• Inadequate skin coverage or when the implant used is too large for skin coverage
• If the silicone molecules enter into the pocket holding the implant