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Charles A. Messa, III, MD, FACS

Capsular Contracture: A Closer Look at This Breast Implant Complication

Posted November 30, 2023 in Capsular Contracture

5 Min Read: 

Breast augmentation remains one of the most popular cosmetic procedures, with nearly 300,000 breast augmentations performed last year. Although this procedure is very safe, in a few cases, complications can occur with implant-based breast augmentation, including capsular contracture.

Young woman checking her breast on white background. Cancer awareness concept

What Is Capsular Contracture?

Following a breast augmentation, the body naturally responds to all implants (medical and cosmetic) by creating a capsule of scar tissue around it. The scar tissue capsule that develops around breast implants helps keep them in one position and protects the breast pocket.

A problem occurs when the scar tissue hardens and tightens around the implant. This complication is called capsular contracture, and it can cause the following issues for patients with implants:

  • Chronic pain
  • Increased firmness or tightness in the breast
  • Change in breast position or shape
  • Restricted range of motion

Capsular contracture can be painful and alter the shape of the implants. In some cases, the breast implants will feel hard and appear distorted. Not only is this aesthetically unappealing, it can be painful.

The severity of capsular contracture is rated on a grading system of the symptoms the patient is experiencing:

  • Grade 1:  Asymptomatic (having no symtoms)
  • Grade 2:  Minor cosmetic symptoms only
  • Grade 3:  Obvious cosmetic symptoms but little to no pain
  • Grade 4:  Obvious cosmetic symptoms with tenderness or pain to the touch

If you are experiencing capsular contracture or any other issues with your breast implants, contact your plastic surgeon.

If you are experiencing a more comprehensive range of symptoms, you may be experiencing breast implant illness (BII). You can read our blog, Are You Worried You Have Breast Implant Illness?, to learn more about BII, its symptoms, and treatment.

What Causes Capsular Contracture?

Capsular contracture occurs in approximately 5% of women who undergo breast augmentation. This complication can be caused by one or more factors, such as:

Low-Grade Bacterial Infection

Capsular contracture can develop due to the formation of a biofilm within the breast pocket. Biofilm is a thin layer of bacteria that is often introduced to the body when the implant is inserted into the breast cavity during augmentation. This collection of bacteria can cause an infection, which can lead to capsular contracture.

Hematoma and Seroma

Some patients may need to use drains to help ensure that blood (hematoma) and fluid (seroma) do not collect within the breast pocket. This collection provides nutrients for bacteria to feed on, thereby increasing the development and growth of capsular contracture-causing biofilm.

Breast Cancer Treatment

Women who choose implants for their breast reconstruction (after mastectomy or lumpectomy) might have a higher rate of developing capsular contracture if they choose to insert their implants before finishing all of their cancer treatment (such as radiation).

Genetic Predisposition

Pre-existing conditions and genetics are also important to consider. Capsular contracture is essentially an over-active response to a foreign object (the implant) in the body, so patients prone to developing thick scar tissue or having a family history of autoimmune disease may be at a heightened risk of developing this complication.

Bad Luck

It is also possible that this condition can arise at random with no easily identifiable cause. This comes down to nothing more than chance and a defensive natural response from the body.

What Are the Early Signs or Symptoms of Capsular Contracture?

The earliest signs of capsular contracture include:

  • Mild tingling of the implants
  • The distorted appearance of the breasts
  • Firm feel of the implants

In a majority of cases, capsular contracture starts during the healing process and can become problematic within the first two years following breast augmentation. However, in rare cases, scar tissue can develop and constrict the breast pocket (capsular contracture) years after the procedure.

It is important to listen to your body and be aware of any changes you experience. Breast augmentation, while widely regarded as a safe procedure, does carry some risk, and it often requires some additional surgery to maintain or remedy the breast implants.

How Can I Prevent Capsular Contracture?

There is no way to prevent capsular contracture; however, some methods have been shown to reduce the possibility of it. Many of these come from the specifics of your breast augmentation surgery.

Statistics show that saline implants have a higher risk of developing capsular contracture than cohesive gel implants (silicone), and textured implants may be more protective than smooth silicone implants. Additionally, implants placed under the muscles (sub-muscular) are also thought to be less likely to develop contracture since the pectoral muscle massages the implants, allowing the scar tissue to remain soft.

How Can I Treat Capsular Contracture?

Capsular contracture is one of the most common causes of breast surgery revision. To correct capsular contracture, patients often undergo a secondary breast augmentation with a capsulectomy. A capsulectomy is a surgical procedure where your surgeon removes the breast implant and the surrounding scar tissue. A new implant can be inserted during this time. Because capsular contracture is highly treatable, it is not a hindrance for women who want to keep their breast implants.

Some patients may desire to remove the breast implants (explantation) and capsule permanently. Plastic surgery is always a personal decision, as is the choice to undo cosmetic surgery. After encountering issues with their breast implants, some women may decide they no longer want to deal with the maintenance that comes with breast augmentation surgery.

Additionally, explantation may appeal to women who might not have symptoms yet but are unwilling to remain open to risks. In any case, your plastic surgeon can help you restore comfort and peace of mind if you are unsure if you want to keep your breast implants.

Want to Learn More About Your Options for Capsular Contracture and Breast Augmentation?

Capsular contracture is a common occurrence that is easily treatable. If you begin to notice abnormal changes in your breasts following your augmentation, contact your surgeon as soon as possible.

Dr. Charles Messa III is a double board-certified plastic surgeon serving Weston, FL, and the surrounding areas. If you think you have capsular contracture, BII, or want to learn more about your options for breast augmentation, breast implant revision, or explantation, call Weston Cosmetic Surgery Center today at (954) 659-7760.

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2823 Executive Park Dr, Weston, FL 33331