Capsular Contracture – What is Capsular Contracture, Causes, Risks, Signs, Treatment

You may be concerned about capsular contracture if you’ve had or considering breast augmentation surgery.

This article first defines what capsular contracture is in breast surgery. We then describe who is at risk of developing it, the signs and symptoms and various treatment options. 

Before you start reading, it is worth noting that most capsular contractures are correctable with proper medical oversight. We discuss the available treatments below. 

What is Capsular Contracture in Breast Surgery?

Capsular contracture is a complication after breast enlargement with implants. The condition occurs when the body forms a hard tight “capsule” of scar tissue around the implant, squeezing it, causing pain and unwanted shape changes. 

According to the American Society of Plastic Surgeons, capsular contraction is “the formation of a “capsule” of scar tissue around any kind of implant (medical or cosmetic) is a normal part of the healing process. In some patients, however, this capsule of scar tissue becomes unusually hard and starts to contract around the implant.”

The Different Types of Capsular Contracture in Breast Augmentation

Medical professionals identify various forms or “grades” of capsular contracture according to the severity, based on the Baker scale:-

• Grade I: The breast appears normal, soft, and natural. The capsule surrounding the implant is not contracted.
• Grade II: The breast feels a little firm, and there is evidence of the capsule contracting slightly. 
• Grade III: The breast is abnormally firm and has an unnatural shape. Scar tissue around the capsule may be causing it to displace and its appearance to change. 
• Grade IV: The breast is hard and looks very distorted and abnormal. Patients are at risk of implant rupture or extrusion. 

Understanding the Causes of Capsular Contracture After Breast Surgery

 The exact causes of capsular contracture are not fully understood, but some possible factors include:-

• Implant rupture
• Bleeding
• Genetic predisposition
• Inflammation
• Infection

Most causes of capsular contracture relate to an undesirable immune response. Chemical factors activate the immune system, forming tough scar tissue around the implant, leading to unwanted deformation. 

Genetic factors may also play a role. Even with high-quality treatment and aftercare, you may not get the desired result in these cases. 

Who is at Risk of Developing Capsular Contracture?

Clinical evidence suggests that some individuals are at a higher risk of capsular contracture than others. With that said, the condition can affect anyone who has had breast implants in the past. 

Factors Influencing Capsular Contracture Risk in Breast Augmentation

Factors that increase the risk of developing capsular contracture after breast augmentation include: 

• A history of radiation therapy to the chest (for instance, frequent mammograms, chest X-rays, or cancer treatments)
• A ruptured or leaking implant (either due to a poor-quality prosthesis or impact)
• Smoking or using nicotine-containing products
• Failing to follow post-operative instructions thoroughly
• Developing an infection or significant bleeding after surgery

Most capsular contractures occur during the first two years after surgery. However, it may happen at any time once the body starts to heal, worsening over several months. 

According to published research, (1)”Capsular contracture is known to increase over time and often causes distortion and hardening of the breast mound. Techniques to prevent or minimise its occurrence are related to meticulous handling of the implant, ensuring a bloodless operative field, and antibiotics.”

Reducing the Risk of Capsular Contracture in Breast Surgery

There are several ways to reduce the risk of capsular contracture in breast surgery. 

First, choose the right size and type of implant for your anatomy. Choosing implants that are too large or made of the wrong materials could initiate an unwanted immune response and impair the body’s healing ability. 

Second, take antibiotics and anti-inflammatories after the procedure. These medications will help to minimise the immune response, reducing the risk of complications. 

You can also massage the implant regularly to keep it soft and mobile. This technique may further reduce the risk of complications or other issues. It may also reduce the build-up of fibrous material inside the breast, reducing the risk scar tissue will squeeze and distort the implant. 

Recognising the Signs and Symptoms of Capsular Contracture

The signs of capsular contracture are usually quite obvious. Here are the symptoms you should look out for:-

• Breasts that feel harder or firmer to the touch than usual
• Breasts that look distorted or uneven when viewed from the side or front
• One breast that appears to move up the chest or away from the other breast
• Trouble moving your shoulders or chest muscles (for example, while pushing or pressing with your arms)
• A rippling or wrinkling of the skin over the implant

If you see any signs developing, contact your plastic surgeon immediately. They can advise whether you are experiencing capsular contracture and the various treatments available. 

How to Treat and Reverse Capsular Contracture After Breast Augmentation

Capsular contracture can be treated in several ways, depending on the severity and the patient’s preference. Options fall into three broad categories – medication, surgery, and non-surgical techniques – which we discuss below. 

Corrective Surgery Options for Capsular Contracture in Breast Surgery

Two mainstream surgical options exist for capsular contracture after breast augmentation: capsulectomy and capsulotomy. 

Capsulectomy is a surgical procedure that involves removing the implant and the entire capsule of scar tissue around it. This procedure eliminates capsular contracture and reverses breast augmentation, meaning your breasts will return to a similar shape and size as before your original surgery. You can ask the surgeon to insert a new implant to replace the old one, but capsular contracture may occur later. 

A capsulotomy is another surgical procedure that involves cutting or scoring the capsule of scar tissue to create more space for the implant. In this instance, surgeons do not remove the implant, helping you keep the results of your first surgery. 

The treatment is popular because it improves the breasts’ appearance while maintaining size and shape. However, scar tissue may re-form, initiating capsular contracture for a second time. 

En Bloc Capsulectomy: An Effective Solution for Capsular Contracture

En bloc capsulectomy is one of the most effective treatments for capsular contracture. This surgical procedure removes the implant and the entire capsule in one piece without opening or rupturing it. As such, the approach helps to prevent leakage of implant material or bacteria into the surrounding tissue, which could cause inflammation, infection, and the recurrence of capsular contracture. 

The technique is also prophylactic. Research suggests en bloc capsulectomy reduces the risk of breast implant-associated lymphoma, a rare type of cancer that can develop in some women who receive textured implants. 

Surgeons perform en bloc capsulectomy under general anaesthesia. The operation takes about two hours. 

Surgeons begin with an incision along the previous scar from the implant surgery. They then separate the capsule from the surrounding tissue, removing it and the implant as a single unit. They may then insert the new implant wrapped in a skin substitute material to reduce the formation of further scarring. 

Recovery from en bloc capsulectomy may take several weeks; you may experience pain, swelling, bruising and drainage during this time. Taking painkillers, antibiotics, and anti-inflammatory medication as your surgeon prescribes is essential. 

Breast Surgery Techniques to Minimise Capsular Contracture Development

The good news is that high-quality surgeons use techniques that minimise the risk of capsular contracture developing. These include:-

• Using a surgical drain to remove excess fluid and blood after surgery
• Placing the implant under the muscle rather than over it
• Minimising implant handling and contamination during surgery

In some cases, surgeons may use Povidone-iodine irrigation. This antiseptic solution can rinse the implant pocket and implant before insertion, reducing bacteria load and preventing biofilm formation. 

They may also use an acellular dermal matrix to cover and replace part of the damaged capsule. This biological material is a barrier to reducing or preventing inflammation and scarring, making it ideal for repeat contracture cases. 

For these reasons, choosing a quality surgeon like Mr Ahmad is essential when considering breast enlargement. Patients should select surgeons with the necessary skill and expertise to conduct operations according to established best practices.  

Post-Operative Care and Capsular Contracture Prevention in Breast Augmentation

Post-operative care is essential for preventing capsular contraction after breast augmentation. Failing to get it right can affect the cosmetic outcome and damage your quality of life. 

Your surgeon will provide a list of post-operative instructions you can take home once you leave the clinic. These outline how you should care for your breasts during and after recovery. 

Surgeons will begin by advising on wound care, antibiotics, pain relief and activity restrictions. You should not do any strenuous exercise for several weeks after the operation and take medications as prescribed. 

You should also wear a supportive bra or compression garment as instructed by the surgeon to reduce swelling and bleeding. These items reduce internal forces in the breast during healing, speeding your recovery. 

Another way to prevent capsular contracture after breast augmentation is to avoid smoking, alcohol and anti-inflammatory drugs that can impair healing and increase inflammation. Again, your doctor will provide more specific information on the medications you should avoid. 

Many professionals recommend you perform regular massages on your breasts after surgery. These prevent scar tissue formation and can reduce contractions around the implant. You can learn more about the types of scars and how to minimise them here.

You should report any signs of infection, seroma, or hematoma to your surgeon. These conditions can trigger inflammation leading to capsular contracture. 

Non-Surgical Treatment Options for Capsular Contracture

If you don’t want surgery but still want to improve your capsular contracture symptoms, your doctor may recommend non-surgical options. These do not involve cutting into the breast tissue. 

The Role of Massage and Physical Therapy in Capsular Contracture Management

Massage plays a key role in capsular contracture management. The technique aims to keep breast tissue flexible and healthy, reducing the risk of fibrous, dense scar tissue from forming. 

Physicians may recommend various techniques to keep the implant socket soft, including:-

• Pressing your elbow across your breast with the opposite hand on your shoulder
• Squeezing the implant firmly with your left and right hand on either side of the breast
• Applying gentle pressure to the breast and implant from down, left and right, pushing it to the centre of the chest. 

You may need to perform these massages several times daily for a few minutes to get the best results. Treatment should start a week after surgery, and massaging the breasts before this time could lead to unnecessary and avoidable damage, potentially increasing the risk of capsular contracture. 

Medications and Supplements to Address Capsular Contracture in Breast Surgery Patients

Various medications and supplements exist to address capsular contracture in breast surgery patients. Options include:-

• Leukotriene inhibitors. These drugs block leukotrienes, a chemical in your body that causes inflammation and contraction of smooth muscle cells. Medical professionals usually use this drug for asthma patients, but they can help with capsular contracture, too.
• Vitamin E. This supplement is a natural antioxidant that may have some effect on scar formation and healing. Most patients take it orally, though you can apply it directly to the skin. With that said, the evidence for the efficacy of vitamin E in treating capsular contracture is minimal.
• Antibiotics. While it might sound like a simple intervention, antibiotics are one of the most effective ways to reduce the risk of capsular contracture. After surgery, reducing the bacterial load inside the breast capsule lowers the body’s inflammatory response. 

Your surgeon will provide more information about the options available to you. You should always tell the presiding physician whether you take any additional medications in case these interact with your prescription or inhibit healing from breast augmentation surgery. 

Please note that drugs and supplements won’t usually reverse capsular contracture but ease symptoms. In these cases, surgery or physical manipulation may be the only options. 

Frequently-Asked Questions:

What are the early signs of capsular contracture?

Early signs of capsular contracture include breasts that feel firm or hard or look distorted. You may also notice your breasts move unnaturally. Pain and discomfort are common symptoms and nipples that change shape or position. 

Does capsular contracture go away?

Unfortunately, capsular contracture does not go away on its own, and that’s because scar tissue persists once it forms. The body can remain in an uncomfortable configuration indefinitely unless you seek treatment. Fortunately, many surgical and non-surgical options are available, as discussed above. 

How do you fix capsular contracture?

There are several methods for fixing capsular contracture. First-line treatments usually involve medications and massage therapy. Drugs help to reduce the body’s inflammatory response, making the formation of scar tissue around the implant less likely, while massage helps to promote tissue softness, preventing it from tightening up and causing changes in the breasts’ shape and structure. 

Surgeons may also recommend surgery. One of the best forms of surgery is en bloc capsulectomy. This surgery removes the scar tissue and implant as a single unit, reducing the risk of infections. 

Who is prone to capsular contracture?

People prone to capsular contracture include individuals with a history of radiation therapy, hematoma, or a genetic predisposition to developing the condition. It is also more common in people who choose low-quality clinics for cosmetic treatment or smoke/drink immediately after the operation. However, it can occur to anyone after breast augmentation surgery. 

What happens if I get capsular contracture?

If you get capsular contracture, you should immediately speak to your doctor or surgeon. They will perform various diagnostics, telling you if you have the condition and the treatment options available. They will also explore why it happened to prevent recurrence in the future. 

When is the most common time for capsular contracture?

Capsular contracture can occur at any time following breast augmentation surgery. However, it is more likely to happen in the first two years after surgery because scar tissue forms as the body heals, causing changes in the shape and texture of the breasts. 

References:

Science Direct