Capsular Contracture

Please know what  capsular contracture is before you have a breast implant operation and how capsular contracture affect your breast implant and your breasts. Capsular contracture is the leading cause for a re-operation following a breast implant operation- there are a number of other causes like implant malposition, wrinkling and rotation that you should also learn about.

But you must know what  capsular contracture is and how to reduce your risk of having capsular contracture before you have your breast implant operation.

What is capsular contracture?

Capsular contracture is the hardening of tissue around the breast implant; it is the most common reason for re-operation following a breast augmentation or breast augmentation revision. The scar tissue that normally forms around the mammary implant will form a capsule, this capsule may tighten or squeeze the implant resulting in capsular contracture.

Capsular contracture is measured in terms of Baker Grades, with grades 1 & 2 not defined as a severe capsular contracture while grades 3 & 4 describe the breast as firm, abnormal looking, hard and painful.

The cause or event that leads to a Baker grade 3 or 4 capsular contracture is not completely know but hematoma, seroma and infection have all been studied as an indicator of possible capsular contracture or a cause. Capsular contracture happens over time, Dr. Neal Handle found the risk of capsular contracture does not decrease with the time from implantation.

The rates of capsular contracture vary according to implant surface type (smooth, textured or Polyurethane foam) and surgical indication- primary augmentation has a lower rate of capsular contracture than revision augmentation or breast reconstruction.

It has been shown that Polyurethane implants have a significantly lower rate of capsular contracture than smooth or textured breast implants; here is a summary of a report by a leading breast surgeon regarding the different types of implant surfaces and capsular contracture and the full report can be downloaded here: The Case for Polyurethane Foam Silicone Breast Implants.

What the FDA says about capsular contracture

The following is from the FDA website:

The most common local complications and adverse outcomes associated with breast implants — silicone gel-filled and saline-filled—are capsular contracture, reoperation, implant removal, and rupture or deflation of the implant.

and

Capsular contracture is the hardening of the breast area around the implant. It can occur in the tissue surrounding one or both implants. This hardening causes the tissue to tighten, which can be painful. There are four grades of capsular contracture, known as Baker Grades. Grades III and IV capsular contracture are considered severe, and may require reoperation or implant removal. Capsular contracture, whether mild, moderate or severe, may occur more than once in the same implant.

What causes capsular contracture:

This is the hard part- the exact cause is not known as a capsule forms around every implant. The question is why are some capsules good and others become hard and cause a re-operation. There are factors that have been identified as the causes:

  • germs or a contaminate- these could enter the capsule attached to the implant shell or during the breast implant operation
  • infection- if infection around the implant occurs following the breast implant operation, it could lead to capsular contracture at some point, but not always
  • seroma or hematoma during or following the breast implant operation could lead capsular contracture at some point, but not always

Implant surface and capsular contracture:

The following is taken directly from two major implant manufacturer data sheets- this information was submitted to the FDA:

IMPLANT MANUFACTURER SiliconeImplant Surface Type PATIENTS IN STUDY STUDY TIME FRAME CAPSULAR CONTRACTURE RATE (Baker Grade 3 & 4)
Allergan® Smooth/Textured 455 7-Year 15.5%
Mentor® Smooth/Textured 551 3-Year 8.1%

Polyurethane foam covered silicone gel breast implant are used in over 35 countries around the world and have a documented capsular contracture rate of 1% at 10 years in a study by the Brazilian doctor Vazquez.

How you can prevent capsular contracture:

Select a well qualified doctor that will follow all guidelines for safe and proper breast implant surgery.

Know about the implant you will use. Remember, this is an implant and not some dissolvable filler; this implant will remain in your body and you should know everything about it. Evaluate the types of implants- not just silicone and saline (if you are in the USA), but also the implant surface- smooth, textured and Polyurethane. You should know the safety data and re-operation rates associate with each type of implant.

Don’t smoke. Smoking reduces oxygen in the blood. If you are smoking after the breast implant operation you could be delaying the healing process. The delay could lead to inflammation.

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