What is Capsular Contracture?

Scar tissue forms around all nonabsorbable implanted materials in our bodies, as a natural part of healing. But scar tissue becomes troublesome when it tightens around an implant. As the capsule tightens, a flexible soft natural shaped implant can become a firm round ball and changes the shape of the breast. The capsule often becomes adherent to surrounding skin, breast tissue, muscle, or chest wall and can cause discomfort or pain with exercise, sexual activity, and normal everyday living.  Capsular contracture can occur after a Breast Augmentation with implants and causes the breast to feel firm, unnatural and often painful. The most severe cases can cause strange distorted breast shapes. These contractures can result in a cold feeling breast, affect sleep, contribute to muscle pain, shoulder pain neck and back pain, and in some women cause the feeling of difficulty in taking a deep breath. Capsular contracture can occur anytime but tends to do so in waves called either “early” or “late” capsular contracture. Removal of the capsule with or without and implant exchange usually involves a drain and most women return to work in 5-10 days.

Do I have a capsular contracture?

Contractures can occur any time after the placement of breast implants. There are several probable causes of contracture. Breast tissue naturally has bacteria. Breast implants over time appear to have bacteria that adhere to the implant shell, called a biofilm. This is not an infection, and does not respond to antibiotics, but can cause a slow inflammation, resulting in a gradual tightening of the capsule. Some studies suggest that blood in the pocket at the time of augmentation may increase your risk, and some contractures do not have any known causes. Most women never experience tightening or contracture.

Available Treatment Options

Some women may decide to have implants removed after developing a capsular contraction or may wish to have a revision and replacement of the implants. Current studies have shown that implants should be removed and replaced after capsule removal, and brand-new implants should be used. Keeping the original implants is not recommended since the implant surface has adherent bacteria called a biofilm. Most implant companies now provide a warranty for this condition. The implant companies we use DO warranty implants for contracture at this time.

A capsulectomy (the surgical removal of the capsule) is performed at the time of implant replacement to improve the likelihood of soft breast and potentially reduce the recurrence rate of the capsular contraction. Removal of the capsule generally results in a dramatic breast shape change. These options, however, do not ensure that a capsular contraction will not recur, and patients that have had a contraction are considered a significantly higher risk of subsequent capsular contractions.

A capsulectomy operation involves making an incision along the breast crease, regardless ow where your original incision was placed. The tissue is separated to expose the capsule that can be easily identified. The operation includes dissection (separation of the surrounding) tissue from the capsule. A contracted capsule can be very thin or thickened, can look normal or be covered with calcified areas that resemble tiny eggshells. These findings are identified during surgery and rarely show up on scans including MRIs. Most of the time, the surgery technique involves an en bloc approach which helps remove the capsule with implant inside as a single unit. This is an effective way to help reduce siligone spillage with ruptured implants but is not always advisable depending on the consistency of the capsule when it is very thin and adherent to rib or other structures. None the less, when a capsulectomy is complete, the goal is to have no remaining visible resectable lining left.

Most women find that following the operation they may need some pain relief for 24-48 hours, and most find that within 24 hours acetaminophen is effective. Driving can resume in 3-4 days, return to exercise in 3 weeks, and swimming and beach visits in 1 month.

The decision to re-implant should be carefully deliberated. If you have developed a capsular contracture once, you are at higher risk of a recurrence. If your implants were originally above the muscle, the option of replacing below the muscle may be considered. In some cases, the best option is to remove the implant and capsule, allow for healing, then consider options at a later date.

All tissue removed during surgery will be sent to pathology for evaluation. It is extremely rare to find any issue with the tissue. However, patients that have had textured implants have a very small risk over time of developing BIA ALCL (breast implant-associated anaplastic larger cell lymphoma) which in the overwhelming majority of cases is cured with a capsulectomy. These can develop to look like a contracture but often present with a fairly rapid size increase over weeks to a few months.

Capsular Contracture Classification

Correcting capsular contracture involves several factors including: the extent of the damage, how soon it occurred after implant placement, lifestyle, patient history and expectations. The most common classification system used by Board Certified Plastic Surgeons is the Baker Classification;

  • Baker I – Describes a breast that is soft and feels and looks normal.
  • Baker II – Involves a breast that is slightly firm, often feeling. different from the opposite breast, but with no visible changes.
  • Baker III – Capsular contracture is significantly firm, with visible changes in shape or contour.
  • Baker IV – The breast is very firm to hard, easily palpable implant, significant visible change, may feel cooler to the patient and is or may be painful with normal activity.

Receiving a Professional Consultation

Dr. Rudderman believes the consultation is critical for you and him. The consultation includes the following: full evaluation of your original surgical experience including implant type and location, placement and technique used. This information can yield insight into the contributing factors to the capsular contracture. During the consultation implant positioning, size, capsular contracture severity, and soft tissue characteristics will be assessed to estimate expected postoperative appearance. Many symptoms may resolve quickly after implant and capsule removal. Capsules removed are typically sent for pathologic evaluation, and patients receive a written report of findings from the pathologist.

All of your questions will be answered and your concerns addressed. Dr. Rudderman has done hundreds of breast surgeries and can project your likely outcomes. This is done in an embracing, relaxing environment. From the consultation evolves…trust, respect, mutual understanding and a personalized treatment plan.

These treatments are not an emergency, and plenty of time will be allowed to have a full conversation to consider options. Additional visits can be provided until you feel confident that you are making the best decision for yourself in health, safety, and outcome.

Dr. Rudderman has done hundreds of breast surgeries and can project your likely outcomes. From the consultation evolves…trust, respect, mutual understanding, and a personalized treatment plan.

After your first consultation with Dr. Rudderman, you will realize that there truly is a difference in how surgeons approach their profession. For Dr. Rudderman…that difference means understanding your goals and providing a level of service that places safety and comfort alongside predictable and pleasing outcomes.

Contact us at 678.566.7200 to meet with Dr. Rudderman in our Alpharetta or Midtown Atlanta offices.

Written and reviewed by:

This article was written by Dr. Randy Rudderman, who is board certified by the American Board of Plastic and Reconstructive Surgery (1994). He practices medicine at his offices in Alpharetta and Atlanta.
Learn more about Dr. Rudderman, his medical training, and credentials.

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