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Capsular contracture is pathological scar tissue that forms after breast implant placement and can result in an alteration of breast shape and/or pain.
The formation of scar tissue around any implant placed in our body (e.g., artificial joint, silicone implant) is a normal process. Our body attempts to encapsulate the foreign object and isolate it. In the case of breast implants, this helps to keep them in the desired position (like an internal “bra”). Sometimes, the scar tissue that forms becomes excessively hard and begins to contract around the implant. This can lead to aesthetic problems and, in advanced cases, pain in the implant area.
Capsular contracture is classified into 4 stages:
1: No symptoms, breasts remain soft to the touch, and there is no change in shape.
2: No change in shape, but breasts are firm to the touch.
3: Breasts are firm and there is a change in shape.
4: Breasts are firm, there is a change in shape, and pain.
In 75% of cases, capsule formation occurs within 2 years after implant placement. If it occurs after many years, implants should be checked for possible rupture.
The main predisposing factors for capsule formation are hematoma (blood clot formation) and inflammation. These can be addressed to some extent by taking all necessary intraoperative precautions and applying “ lege artis” surgical technique. Nevertheless, even with excellent surgical technique, capsular contracture can sometimes develop due to the patient’s predisposition. Each patient heals differently, which is why some develop unsightly, large scars while others have imperceptible ones after similar injuries. The overall risk of capsule formation is 8-12% for submuscular implant placement and 12-18% for subglandular implant placement.
How can we treat capsule formation?
Conservative methods have been used to treat capsular contracture, such as massage, external pressure application attempts, ultrasound, corticosteroid or fat injections, with questionable results. Surgical treatment, which consists of removing the implant, removing all or part of the capsule depending on the circumstance, and possibly changing its position (e.g., if it was subglandular, placing the implant submuscularly), offers the best results. In any case, the patient must be aware that after capsule removal, the probability of the capsule reforming doubles. Thus, if the probability of capsule formation in the initial surgery is approximately 10%, in revision surgery it is 20%.
Photo:
Surgical correction of right breast capsular contracture before and after.