What is Capular Contracture?

When any type of Breast Implant is inserted, the body reacts by forming a protective lining around it. This is referred to as the "Capsule" or "Tissue Capsule". Some people refer to it as the "Scar Capsule" although it is not exactly the same as scar tissue. The Capsule is formed by your own living tissue. It is normal and happens in everyone regardless of whether the Breast Implant is smooth or textured, silicone or saline. 

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Capsular Contracture is classified according to the following subjective scale (known as the Baker Classification). Fundamentally, the tighter the capsule becomes the firmer the breast feels and the more abnormal it appears.

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Grade I – the breast is normally soft and appears natural in size and shape.

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Grade II – the breast is a little firm, but appears normal.

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Grade III – the breast is firm and appears abnormal, there is no pain.

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Grade IV – the breast is hard, painful to the touch, and appears abnormal.

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What causes Capular Contracture?

The exact mechanism that leads to Capsular Contracture is still unknown, however it is hypothesized that inflammation is the trigger that causes the contraction of the normal breast capsule.  The inflammatory process then leads to contraction of smooth muscles cells.

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Incidence of Capsular Contraction

Published rates of Capsular Contracture in Breast Augmentations are usually reported at about 8% at 5 years, while incidence in our patients ranges between 1 – 5%. The exact numbers vary, and some surgeons claim their rates to be 1% or less; although, there are no independently verifiable rates that low. In general, Capsular Contracture is the the most common cause of re-operation after Breast Augmentation, which most often takes places during the first year after surgery.

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What can be done to reduce the risk of Capular Contracture? 

Capsular Contracture is one of the most researched topics in Cosmetic Breast Surgery. Although the exact cause of this condition is not known, it is thought to result from the combination of multiple factors. Evidence suggests that contamination, bleeding, and an implant placement above the chest muscle (Sub-Glandular or Sub-Mammary) of smooth Breast Implants increase the risk, while using a textured implant placed under the muscle (Sub-Muscular or Sub-Pectoral) through a breast fold incision is the best way to significantly reduce the risk. There is no difference between the use of silicone and saline implants.

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The following have been found to be factors that increase the risk of Capsular Contracture occurring:

• Above muscle placement (vs. below)

• Textured implants (vs. smooth)

• Peri-areolar incision (vs. Breast Fold incision)

• Peri-areolar incision (vs. Breast Fold incision)

• Larger implants (greater than 420 ccs)

• Use of a post-operative bra

• Development of hematoma/seroma after surgery

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Leukotriene Receptor Antagonists (such as Singulair) prevent the action of various inflammatory mediators and have been shown in various studies to prevent or reverse Capsular Contracture.

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What is the Treatment for Capular Contracture?

The treatment of capsular contracture is usually surgical. In an "Open Capsulotomy" Mr Khan scores, or cuts, the capsule to release its hold on the implant. In an "Open Capsulectomy", the entire capsule is surgically removed. The body then forms a new capsule but the hope is that it does not contract as the old one did. Capsulectomy is a more extensive operation than Capsulotomy but has a higher rate of success in Correcting Contracture. Only a relatively small percentage of women with implants develop Capsular Contracture severe enough to require surgical treatment. The rare patient develops repeated Capsular Contracture but in the majority of cases it can be successfully treated. 

 

Recovery after the Capular Contractor Surgery

After Capsular Contraction Surgery you can undertake light activities (including light aerobic exercise) once you feel comfortable, and after the first 2 weeks you can start to lift everyday objects. It is important not to do upper body weights or rigorous exercise until 6 weeks following the surgery. Your body will be a good guide as to what you can and can’t manage!

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Although success rate following surgery are high, there is a higher risk of redeveloping Capsular Contracture if you have had it occur once already. If this were to occur a further release of the Contracture could be undertaken together with other potential steps to reduce risk of recurrence.