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At Centre for Surgery in London, breast augmentation surgery with implants has become one of the most popular cosmetic procedures in the UK. For women who are unhappy with their small, asymmetrical or deformed breasts, breast enhancement can be the perfect solution to achieve bigger, more beautiful, and more youthful-looking breasts.
RELATED: 3 breast implant safety considerations to know about
However, like any other surgical procedure, there are some complications that can arise with breast implants over time, causing distress to both the patient and the plastic surgeon. One of the most common and undesirable outcomes is known as capsular contracture.
So, what exactly is capsular contracture? In simple terms, it is a condition where the body forms tight fibrous bands around the breast implants, which pull on the breast tissue, causing deformity and pain. It is also the most common complication associated with breast implants.
Thankfully, there are ways to reduce the risk of capsular contracture happening. With several surgical and non-surgical treatments available, and new methods being developed every day, there is no need to worry.
If you are considering breast augmentation surgery, it is essential to understand the risks associated with it. Capsular contracture is just one of those risks, but it is important to note that it doesn’t happen in every case.
To prevent capsular contracture, it is crucial to follow the post-operative instructions provided by your surgeon and attend all follow-up appointments. Additionally, choosing a skilled and experienced surgeon who uses high-quality implants can also lower the risk of complications.
If you do experience capsular contracture, there are several treatment options available. These can range from non-surgical methods such as massage, medication, and ultrasound therapy, to more invasive procedures like implant removal or replacement. Your surgeon will discuss the best course of action based on your individual needs and preferences.
What is capsular contracture?
Capsular contracture is a condition that can occur after breast augmentation surgery. When a foreign object, such as a breast implant, is placed in the body, the immune system responds by creating a protective barrier of scar tissue around the implant. This barrier is known as the “fibrous capsule” and is a natural part of the healing process.
In most cases, the fibrous capsule is thin and does not cause any problems. However, in some women, the immune response can become exaggerated, causing the fibrous capsule to thicken and contract around the implant. This can result in the breast feeling hard, distorted, and painful. In severe cases, the breast can even become misshapen and deformed.
The severity of capsular contracture can vary from person to person and can depend on several factors, including the type of implant used, the surgical technique used, and the patient’s individual healing process. Some women may experience capsular contracture shortly after surgery, while others may not experience it until years later.
Fortunately, there are several ways to prevent and treat capsular contracture. Choosing a skilled and experienced surgeon who uses high-quality implants can help reduce the risk of developing the condition. Additionally, following post-operative instructions carefully and attending all follow-up appointments can help catch any issues early and allow for prompt treatment.
If capsular contracture does occur, there are several treatment options available. These can range from non-surgical methods, such as massage and medication, to more invasive procedures like implant removal or replacement. Your surgeon will recommend the best course of action based on the severity of the condition and your individual needs.
Capsular contracture can cause a significant amount of distress for both patients and their plastic surgeons, especially in severe cases. In its most severe form, capsular contracture can cause the breast to become firm, hard, deformed, unnaturally round, and even painful. This can lead to discomfort and dissatisfaction with the results of the breast augmentation surgery.
To address this issue, several classification systems have been developed to grade the severity of capsular contracture, including the Baker Classification. This classification system ranges from grade I (soft breasts with a natural look) to grade IV (extremely hard breasts that are painful and distorted).
Treatment options for capsular contracture vary depending on the severity of the condition. In mild cases, non-surgical treatments such as massage, medication, or ultrasound therapy may be recommended. However, in more severe cases, surgical intervention, such as breast implant removal or implant replacement, may be necessary.
Research is ongoing to find new and improved ways to treat and prevent capsular contracture. In recent years, some studies have focused on the use of acellular dermal matrix grafts, which are a type of surgical mesh that can help support the implant and prevent the formation of excessive scar tissue. Additionally, some surgeons are exploring the use of specialized implant coatings that may help reduce the risk of capsular contracture.
Why does capsular contracture occur?
Capsular contracture is a common complication that can occur after breast enhancement surgery, and while it is a well-known phenomenon, the exact cause is still not completely understood by doctors in the UK. However, researchers have proposed a few different theories that may explain why some women develop this condition.
One theory suggests that an exaggerated immune response may be to blame. When a breast implant is inserted, the body will naturally create a capsule made up of collagen and other cells to surround the implant and isolate it. This is a normal part of the healing process and typically does not cause any issues. However, in some cases, the immune response can become more aggressive, leading to the formation of a thicker capsule with large, tough fibrous bands that can cause capsular contracture.
Another theory proposes that an adverse inflammatory reaction may be responsible. This theory suggests that the implant may become contaminated with bacteria during surgery, which can lead to an inflammatory response in the breast tissue. Over time, this inflammation may cause the formation of a thick fibrous capsule around the implant, leading to capsular contracture. While many surgeons take steps to prevent contamination during surgery, such as using triple-antibiotic irrigation of the breast and strict sterile techniques, the evidence supporting this theory is still limited.
It is worth noting that capsular contracture is a multifactorial condition, meaning that there may be multiple factors that contribute to its development. Other potential factors may include the type of implant used, the surgical technique used, and the individual patient’s biology. While the exact cause of capsular contracture remains unclear, ongoing research and advancements in surgical techniques may help reduce the incidence of this condition in the future.
Understanding the Risk Factors for Capsular Contracture
Several risk factors contribute to the development of capsular contracture, which can be categorised under various headings such as reason for surgery, breast cancer treatment, breast implant brand, implant filling type, implant shell surface, surgical technique, and time since surgery.
Reason for Surgery: Primary vs Revision Breast Augmentation
The underlying reason for breast enhancement surgery plays a significant role in determining the risk of capsular contracture. Women undergoing their first breast augmentation (primary breast augmentation) have a lower risk of developing capsular contracture compared to those who are undergoing breast implant revision or breast reconstruction after a mastectomy.
Surgical Technique: Submuscular vs Sub-glandular: Implant Placement
During breast augmentation surgery, the surgeon can either insert the implant under the chest muscles (submuscular) or above the muscle and beneath the breast tissue (sub-glandular). Submuscular implant placement carries a lower risk of capsular contracture formation. Furthermore, employing sterile techniques and washing the surgical area with antibiotics can also reduce the risk, as it decreases the chance of bacterial contamination.
RELATED: Breast implant placements – over or under the muscle?
Time Since Surgery: The Progressive Nature of Capsular Contracture
Capsular contracture is a progressive complication, meaning that the longer your implants have been in place, the more likely you are to develop capsular contracture. Regular check-ups and monitoring of your breast implants can help in early detection and management of this complication.
Breast Implant Brand: Choosing the Right One
A multitude of studies has been conducted to assess the risk of capsular contracture with different implant brands. With numerous types, models, and brands of breast implants available, it is challenging to pinpoint which ones carry a higher risk of capsular contracture. Nonetheless, it is essential to choose a reputable brand, such as implants made by Mentor, when discussing options with your plastic surgeon.
Implant Filling Type: Silicone vs Saline
Breast implants are filled with either silicone or saline. Silicone implants are known to provide a more natural look and feel to the breast, while saline implants are easier to place and adjust. Each type has its pros and cons concerning capsular contracture risk, but silicone implants appear to carry a higher risk. However, this assertion remains debated, and the data is not yet conclusive.
Implant Shell Surface: Textured vs Smooth
Breast implants come with either a textured or smooth surface. Textured implants are associated with a lower risk of capsular contracture and can generally maintain their position better than smooth implants. However, it is crucial to note that textured breast implants have been linked to Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL), a rare immunologic cancer that may develop in the breast.
Breast Cancer Treatment and Capsular Contracture
Capsular contracture risk is higher in patients who have received chemotherapy or radiotherapy as part of their breast cancer treatment. These treatments are known to increase the rate of infection and subsequently lead to more extensive fibrosis and contracture.
Identifying Capsular Contracture: Symptoms, Appearance, and Progression
The symptoms of capsular contracture usually progress over time and can increase in severity.
Early Symptoms: Subtle Signs of Capsular Contracture
In the initial stages, the symptoms of capsular contracture can be quite mild and barely noticeable. However, as the condition progresses, these symptoms may become more apparent. If you experience any of the following signs, you might have capsular contracture:
Altered Breast Shape: The Impact of Capsular Contracture
Capsular contracture can lead to breast deformity, where the affected breast may shrink, become more spherical, and exhibit unnatural curvature with an uneven contour. This change in breast shape can be distressing for patients and may require intervention to restore the breast’s appearance.
Changes in Breast Consistency: Firmness and Hardness
As the capsule around the breast implant becomes thicker and tenser, the breast may start to feel firmer, harder, and less consistent. This change in breast consistency is a common symptom of capsular contracture and may indicate that the condition is progressing.
Pain and Discomfort: Capsular Contracture’s Impact on Well-being
When the capsule becomes too tight, it can begin to cause pain in the affected breast. This pain may be mild or severe, depending on the individual and the degree of capsular contracture. It is essential to address this symptom to ensure patient comfort and well-being.
Implant Displacement: The Feeling of Implants Shifting
Some patients with capsular contracture may report a sensation that their breast implant has changed position and feels like it has moved towards their armpit. This symptom may cause distress and should be evaluated by a healthcare professional to determine the appropriate course of action.
Diagnosing Capsular Contracture: Assessment, Tests, and Classification
Consulting Your Plastic Surgeon: The First Step in Diagnosis
If you suspect capsular contracture, schedule a consultation with your plastic surgeon for a comprehensive assessment. During the consultation, your surgeon will inquire about your symptoms, implant type, and details about your breast augmentation surgery. They will then conduct a thorough physical examination of your breast, evaluating deformity, firmness, and any tender points. To confirm the diagnosis of capsular contracture and rule out other causes of breast deformity, your surgeon may order one or more tests.
Diagnostic Tests for Capsular Contracture:
- MRI Scanning – Magnetic Resonance Imaging (MRI) is the gold standard for diagnosing capsular contracture and other breast implant complications. MRI offers high-resolution images that clearly depict the breast implant and surrounding tissue, providing valuable insight for diagnosis.
- Mammography – Mammography is a common test for screening women for breast cancer. It can also be useful in detecting mild to moderate capsular contracture. However, mammography has limited utility in severe capsular contracture cases, as it may not provide sufficient information for an accurate diagnosis.
- Ultrasound – While breast ultrasonography can detect capsular contracture, its accuracy depends on the experience of the doctor performing the test, making the results highly subjective. Consequently, ultrasound may not be the most reliable test for diagnosing capsular contracture.
Baker Classification System: Assessing the Severity of Capsular Contracture
Your plastic surgeon will determine the severity of capsular contracture based on your symptoms, breast characteristics, and imaging results. The Baker classification system is used to categorise capsular contracture severity:
- Baker I: Breasts appear and feel natural.
- Baker II: Minimal contracture with some firmness noticeable by the surgeon, but no other symptoms or deformities.
- Baker III: Moderate contracture, with the breast feeling abnormally firm and exhibiting some degree of deformity.
- Baker IV: Severe contracture, where the breast appears visibly deformed, feels hard, and causes pain.
Treatment Options Based on Severity
After establishing your Baker grade, your surgeon will discuss potential treatment options. Capsular contractures classified as Baker grades I and II typically do not raise concern and do not require treatment. However, Baker grades III and IV are more severe, warranting necessary intervention to alleviate symptoms and restore the breast’s appearance.
Surgical Treatments for Capsular Contracture: Procedures and Techniques
Capsulotomy
Capsulotomy, specifically open capsulotomy, is a surgical revision procedure in which the plastic surgeon cuts the tight bands of the fibrous tissue capsule surrounding the breast implant. The goal is to release tension and restore a more natural breast shape, making it softer without completely removing the capsule. Capsulotomy is less extensive than capsulectomy and is often the preferred method for submuscular implants.
Capsulectomy
Capsulectomy is a more invasive procedure than capsulotomy, involving the complete removal of the fibrous tissue capsule surrounding the breast implant. While it carries higher risks, particularly for submuscular implants, some surgeons prefer this technique, as it ensures the removal of all scar tissue and any contaminants, reduces further contracture, prevents calcium buildup in the remaining tissue, and minimises interference with mammography results.
Implant Replacement
Repositioning the implant may improve outcomes and reduce the risk of recurrence following capsulotomy and/or capsulectomy. A promising technique is the “neo-pocket” formation, where the surgeon creates a new space for the implants.
RELATED: How do I know when my breast implants need replacing?
Autologous Fat Transfer
Autologous fat transfer, currently under investigation as a potential treatment for capsular contracture, involves removing excess fat from another body site (such as thighs, hips, or abdomen) through liposuction and injecting it into the breasts. This process is thought to enhance blood circulation around the capsule, making the breast softer. Fat transfer may be combined with capsulotomy or capsulectomy, or as part of breast reconstruction after implant removal.
Implant Removal
In cases of severe or recurrent capsular contracture, the surgeon may recommend the complete removal of the breast implants. Although this approach usually resolves the problem, the cosmetic results can be undesirable, particularly for those with large implants and excess skin post-surgery. Breast reconstruction after implant removal may involve mastopexy (breast lifting), removal of excess skin, or autologous fat transfer.
Each of these surgical treatments for capsular contracture has its pros and cons, and the choice of procedure depends on factors such as the severity of the contracture and the patient’s individual circumstances. Consulting with a qualified plastic surgeon is essential for determining the most suitable treatment option.
RELATED: Breast Implant Revision
Risk of Recurrence for Capsular Contracture Following Revision Surgery
It is essential to be aware that the risk of capsular contracture recurrence after undergoing revision surgery is relatively significant. Research suggests that approximately one in every four women experiences a recurrence within one year of their corrective procedure. This may necessitate multiple revision surgeries, with each surgery having a heightened risk of recurrence.
New surgical techniques, such as the neo-pocket method, are being studied to minimise the risk of capsular contracture recurrence. As advancements in surgical techniques continue to emerge, there is optimism that these innovative approaches will help reduce the likelihood of recurring capsular contracture post-revision surgery.
Will the NHS cover capsular contracture repair surgery?
The National Health Service (NHS) in the United Kingdom may cover capsular contracture repair surgery under certain circumstances. Generally, the NHS does not cover cosmetic procedures, but if a patient’s capsular contracture is causing significant pain, complications, or impacting their quality of life, they may be eligible for coverage.
Each case is evaluated individually, and the decision to provide coverage for capsular contracture repair surgery depends on the patient’s specific situation and the severity of their symptoms. It is essential to discuss your concerns with your general practitioner (GP) or a specialist, who can help determine whether your case may qualify for NHS-funded treatment.
Keep in mind that NHS policies can change over time, and coverage may vary depending on your local clinical commissioning group (CCG). Always consult with your healthcare provider to get the most accurate and up-to-date information regarding coverage for capsular contracture repair surgery.
Does my Mentor implant warranty cover capsular contracture?
Mentor, a leading breast implant manufacturer, offers warranties for their implants. However, it is important to note that warranty coverage may vary depending on the specific product and the terms and conditions of the warranty at the time of your surgery.
As of the latest update in 2022, Mentor’s UK implant warranty program, the MentorPromise™, includes coverage for capsular contracture in some cases. The MentorPromise™ Protection Plan usually covers Baker Grade III and IV capsular contracture for a specific period of time after the initial surgery, which may include product replacement and financial assistance for the revision surgery.
Keep in mind that policies and warranty terms can change, and it is crucial to review the specific warranty terms and conditions applicable to your implants to understand the extent of your coverage. You can also consult with your plastic surgeon at Centre for Surgery or contact Mentor directly for the most accurate and up-to-date information on warranty coverage for capsular contracture.
How to Prevent Capsular Contracture
Preventing capsular contracture largely involves making informed choices before your surgery and practising proper care afterwards. Factors such as the type of implant chosen, the skill and experience of your plastic surgeon, and appropriate postoperative care all play a part in reducing the risk of developing capsular contracture. Here are the key considerations:
Choosing a Skilled and Experienced Plastic Surgeon
Selecting a qualified, experienced plastic surgeon in London is crucial in reducing the risk of complications, including capsular contracture, after breast augmentation surgery. A skilled surgeon will adhere to strict sterile techniques and procedures to minimise the chances of contamination during the operation. They will also employ implant placement methods that are less likely to cause contracture later on. Additionally, working with a reputable surgeon ensures that you receive proper follow-up care, addressing any potential issues as they arise.
Selecting the Right Implant
The type and brand of implant you choose can significantly influence the risk of capsular contracture. Opting for a reputable brand known for high-quality implants can minimize potential risks. While textured implants have been associated with a lower likelihood of capsular contracture, it is essential to weigh their potential risk of BIA-ALCL against the benefits. Discuss the pros and cons of various implant types with your plastic surgeon during the planning stages of your surgery.
Incorporating Omega-3 Supplements
Preliminary research suggests that fish oil and omega-3 supplements may be beneficial during the healing process by contributing to a less rigid capsule. Incorporating these supplements into your post-operative care routine, as directed by your surgeon or healthcare provider, may potentially help reduce the risk of capsular contracture. Always consult with your doctor before starting any new supplements, especially after surgery.
Practicing Regular Breast Massage
Performing daily breast massages for the first few months following surgery can help improve blood circulation around the implants, leading to a softer and thinner capsule. Gently massage your breasts multiple times a day during the initial three months post-surgery. After this period, you can reduce the frequency to once a day.
Frequently Asked Questions about Capsular Contracture
Can capsular contracture develop suddenly?
Capsular contracture typically develops gradually over time. Symptoms may initially be mild and barely noticeable, but they can progress and worsen. It is unlikely for capsular contracture to occur overnight. However, if you notice sudden changes in the appearance or feel of your breasts, consult your plastic surgeon for a thorough evaluation.
Can capsular contracture resolve on its own?
Capsular contracture typically does not resolve by itself. In most cases, medical intervention is required to address the issue. Mild cases (Baker I and II) may not require treatment, but more severe cases (Baker III and IV) often need surgical or non-surgical interventions.
Is it possible for weightlifting to cause capsular contracture?
While there is no direct evidence linking weightlifting to capsular contracture, excessive strain on the chest muscles could potentially contribute to the condition. It is essential to follow your surgeon’s post-operative guidelines and avoid heavy lifting or strenuous exercise until you receive clearance from your healthcare provider.
Is capsular contracture a dangerous condition?
Capsular contracture itself is not life-threatening, but it can cause significant discomfort, pain, and aesthetic issues. Severe cases can result in breast deformity and may require surgical intervention. Additionally, untreated capsular contracture may lead to complications such as implant rupture or displacement. If you suspect capsular contracture, it is essential to consult your plastic surgeon for evaluation and appropriate treatment.
Schedule a consultation at Centre for Surgery today
At Centre for Surgery, we pride ourselves on providing the highest quality care and personalised experience for our patients. Here are several reasons why you should choose us for your surgical needs:
- Expertise: Our team of highly skilled and experienced plastic surgeons is dedicated to achieving the best possible results for our patients. Our surgeons are trained in the latest techniques and consistently stay up-to-date on advancements in the field.
- Comprehensive Care: We offer a wide range of surgical and non-surgical procedures to address various concerns, ensuring that you receive the most suitable treatment tailored to your individual needs and goals.
- State-of-the-art Facilities: Our modern and well-equipped facilities are designed to provide a comfortable and safe environment for our patients. We utilise the latest technology and adhere to the highest standards of safety and cleanliness.
- Personalised Approach: We understand that each patient is unique, and we take the time to listen to your concerns and expectations. Our team works closely with you to develop a customised treatment plan that meets your specific needs and goals.
- Patient Education: We believe that informed patients make the best decisions about their care. Our team is dedicated to providing you with all the necessary information and guidance to help you make informed choices about your treatment options.
- Aftercare and Support: We are committed to providing ongoing support and follow-up care to ensure your recovery and satisfaction with your results. Our team is always available to address any concerns or questions you may have throughout your treatment journey.
By choosing Centre for Surgery, you can feel confident knowing that you are in the hands of a dedicated and experienced team who prioritises your safety, well-being, and satisfaction.
