Complete the form for guaranteed financing* with a board-certified surgeon:

First Name:

Email

Procedure

State:

* Individual financing rates and monthly payments are determined by credit score. A one time $25.00 credit application fee applies. †Guaranteed Approval applies only to first time customers. Additional loans subject to new credit approval.

Capsular Contracture

The dreaded capsular contracture! We fear it and none of us can tell just who is going to develop it. The truth is, capsular contracture happens. In capsular contracture, the body forms a capsule of living, tightly woven collagen fibers around a foreign body, in this case a breast implant. Some speculate that the capsule forms to shield the body from the foreign object by creating a fibrous wall of tissue between them.

It is also thought that the tissue capsule prevents friction within the body cavity.The key point is that capsule formation is normal. The tightening, or contracture, of this capsule, is when problems begin to surface. The fibrous capsule pulls tight and compresses the implant, creating a breast that can be hard, unnaturally round or otherwise misshapen, and painful.

What Causes Capsular Contracture?

No one knows why capsular contracture forms in one patient and not the next. Some patients will have problems with their first set of implants, but not the second, or the second, but not the first. You can develop contracture in one breast, and not the other.

Capsular contracture occurs in about 5% of patients yet there is simply no way of telling who is going to have problems or when. However, many surgeons believe that certain factors may increase your chances of capsular contracture.

Factors That Increase Capsular Contracture Risks:

Developing a hematoma or seroma
The presence of bacteria, either introduced through the milk ducts, when implants are inserted through the areolae or introduced intraoperatively
Bacterial infections of the pocket or treatment area,
Blood-borne infections or illnesses
After breastfeeding or pregnancy
Radiation therapy, either preoperative or postoperative
Severe trauma to the breast
Silicone gel seeping into the pocket surrounding the implant
Having an autoimmune disorder
Breast implant placement: overs (subglandular) are more likely to develop capsular contracture than unders (subpectoral)

Detecting Capsular Contracture

If your breasts seem deformed, misshapen, and painful or if they have become firmer than when they were first inserted, you may have developed capsular contracture.

There are four levels of capsular contracture as determined by the Baker Grading System, below:

Grade I: the breast is normally soft and looks natural
Grade II: the breast is a little firm but looks normal
Grade III: the breast is firm and looks abnormal (visible distortion)
Grade IV: the breast is hard, painful, and looks abnormal (greater distortion)

How to Decrease Your Chances of Developing Capsular Contracture

You are more likely to develop capsular contracture with subglandular (over) placement. Many surgeons believe that implant placement under the pectoral muscles, or even under the pectoral and serratus muscles and the rectus abdominus fascia, significantly decreases one's chance of developing contracture. The theory is that the constant massage the implant receives from the muscles prevents capsular contracture. However, women still develop capsular contracture with this placement. It may reduce the incidence, but it doesn’t eliminate it.

Some surgeons believe that using textured breast implants reduces the incidence of capsular contracture. However, some studies have reported there is about the same incidence of capsular contracture with either implant shell types.

Talk it over with your doctor before you decide which placement or implant type is best for you.

Some surgeons strongly believe that silicone gel implants reduce the incidence of capsular contracture, although studies have proven that silicone molecules leaching into the pocket around the implant can trigger formation of a contracting fibrous capsule. However, criteria for women to receive silicone gel implants include women who have had problems such as capsular contracture, or even women who have had radiation treatment.

Some surgeons recommend taking a corticosteroid drug called prednisone, right after surgery and for 2 weeks thereafter. Some surgeons instruct their patients to start massaging their implants the day after surgery, which can be painful especially with unders.

What can you do to decrease your chances of developing capsular contracture? Well, for starters ,choose your surgeon wisely. Ask your surgeon what his or her percentage of patients with capsular contracture is.

Because having bacteria in the bloodstream is a risk factor for contracture, and because dental work can push bacteria in the mouth into the bloodstream, you might want to reschedule any major dental work until several months after your breast augmentation surgery. Maintain good oral hygiene, too.

Breast Massage and Compression Exercises to Prevent Capsular Contracture

Some surgeons believe you should regularly perform massage (compressions) or pocket quadrant exercises on your implants and some do not. Quadrant exercises are compressions that displace the implant to the outer most corners of the pocket, up, down, and to each side. You may be told to perform these exercises and hold your implant in each position for a few seconds. Your surgeon should show you how to perform these exercises.

You will usually be asked to start massaging or quadrant exercises about a week after your surgery, but some patients are instructed to massage within a few hours of surgery. If this causes you a lot of pain, tell your surgeon and ask for further instructions.

Sometimes surgeons will instruct you to massage your breasts several times a day until about 3 weeks postoperatively, and then once a day for as long as you have the implants in. The purpose of quadrant massage is to keep the pocket roomy and the capsule loose and elastic.

Some surgeons also tell you to perform compression exercises as well, where you squeeze the implant with medium pressure to keep the capsule flexible and loose.

What Can Be Done About Capsular Contracture Once You Develop It?

There are treatments for severe capsular contracture, but they may not be pleasant. Some surgeons still attempt to remedy the problem by squeezing your breast and implant hard to break up the capsule. This can result in a lot of pain, possible deflation of the implant, and minor to major bleeding in the breast.

Other surgeons prefer a surgical approach and make an incision to reach the capsule. They then lance or score the contracted tissue surrounding the implant to loosen it and break it apart.

Still others treat capsular contracture with injections of corticosteroids. Many surgeons I have spoken to use a regimen of the corticosteroid drug prednisone, vitamin E, and manual compression.

Before these techniques were developed, the only remedy for capsular contracture was removing the implant and removing residual scar tissue.

It is quite possible to develop capsular contracture again. Most patients who get it start having symptoms around 3 months postoperatively. Although you may develop capsular contracture at any time if trauma to the breast or an infection occurs.

New technologies are being developed to treat contracture, including external application of ultrasonic energy waves. Softening of the breasts has been observed after regular low-level treatments of external ultrasound. However, ultrasound can heat the area and if the area is heated for too long may cause weakening of the implant shell and/or burns to the breast tissue.