Do I have capsular contracture? A plastic surgeon explains the signs and symptoms to look out for.
Capsular contracture is a common condition experienced after breast augmentation surgery. Surgeons have made great strides in predicting who may be at greater risk for capsular contracture and have implemented the latest surgical techniques and methods to reduce the number of cases, but, despite best efforts to avoid capsular contracture, some patients will still experience this condition. I am dedicating this month’s blog to support women considering breast augmentation in understanding capsular contracture, the associated risks and symptoms, and what steps to take if you are concerned your breasts may be affected.
What is capsular contracture, and why does it happen?
When breast implants are placed, your body naturally reacts by creating a barrier of tissue to encapsulate each implant; this process is indicative of the normal healing process and helps your breast implants stay in their intended position. The scar tissue that forms around a breast implant is called a capsule.
Capsular contracture is a breast augmentation condition where this normal capsule of scar tissue surrounding one or both of your implants contracts, causing the affected breast(s) to feel more firm. About 10% of breast implant patients experience capsular contracture; symptoms can range from mild (having little felt or cosmetic effect) to extreme (cases in which the complication causes pain and aesthetic anomalies).
Risk factors of capsular contracture
While there is no definitive answer, research supports several theories as to what may cause capsular contracture. How a patient reacts to surgical implants varies and the healing process is dependent upon the individual’s immune system response and connective tissue composition. These unique variables mean complications can and do occur, despite the most advanced surgical techniques and patient screening processes.
Patients may be at a greater risk for developing capsular contracture if they:
Smoke
Are predisposed to developing thick scar tissue
Develop hematomas or blood clots after surgery
Have autoimmune diseases or a weakened immune system
Are natural carriers of staph bacteria which may encourage a “biofilm” to develop around the implant
Do not allow enough time for proper healing before massaging the implants or strenuous activity, thus encouraging more scar tissue to form
Have disproportionately large implants compared to existing breast tissue
Have implants placed over the muscle (subglandular) instead of under the muscle (submuscular)
Breast implants are sterile, surgical-grade, and have undergone extensive trials to ensure they are safe for most bodies. If you do experience capsular contracture, it will not be caused by the selected implant itself, but rather by your body’s natural reaction to a foreign object or bacteria that was introduced during surgery.
Preventing capsular contracture
Preventing this complication in all patients is impossible, but as our understanding of capsular contracture has advanced, so have the screening processes and surgical techniques used to reduce the rate of occurrence. Patients are screened for health conditions and lifestyle choices that may increase their risk for complications and are educated on options to help make the best choice for their body and desired results with their surgeon.
As board certified plastic surgeon, I only perform surgery in an accredited surgical center that meets or exceeds hospital standards for safety and sterility; I will also avoid handling the implant prior to insertion, using methods such as the Keller Funnel implant placement method, which saw an 87% reduction in the rate of capsular contraction. I may also use antibiotic irrigation during surgery. These measures can help limit the introduction of bacteria during the procedure.
What is normal swelling after breast augmentation surgery?
Swelling and mild discomfort are to be expected after breast implant surgery and tend to peak in the first 48-72 hours. Following this, symptoms will gradually subside, with most noticeable swelling resolving by around 6 weeks. Residual breast swelling will continue to diminish over the next 3-4 months; over the course of this period, your implants will “settle in” and start looking and feeling more natural, ultimately revealing your complete results.
Swelling can make the breasts look and feel tight initially—this is normal and no cause for concern—but, as you recover, you should notice a decline in the level of tightness you feel. Internal pressure or skin tension will incrementally diminish unless a complication occurs.
Be mindful of any increase in tightness or swelling, or obvious asymmetry between the breasts. Whether these symptoms occur soon after surgery or many months later, they are considered abnormal and you should see your plastic surgeon for advice.
What are signs that I may have capsular contracture?
Signs of capsular contracture are relatively easy to identify because of the nature of scar tissue. If you notice any of the following, promptly seek your surgeon’s help if:
One or both breast(s) feeling and/or looking unnaturally tight after initial swelling has subsided.
The breast(s) losing a natural profile and instead taking on a more spherical shape.
Pressure from contracting scar tissue producing ripples across the skin.
Breasts sitting too high on the chest; while this is normal in the first few weeks after surgery, the breasts should gradually settle down to a natural position on the chest.
Does capsular contracture always affect both breasts? Can it happen in just one breast?
Capsular contracture can happen singularly in just one breast or occur in both. If both breasts are affected, the severity of the complication may differ between the two implants. In special cases, capsular contracture can affect just a portion of the capsule(s), but as the capsule forms a single unit, this is the least likely circumstance. Whatever the case, I can revise the affected breast(s).
The Baker system for classifying capsular contracture
The Baker classification system is used to determine the severity if capsular contracture is present:
Class 1 capsular contracture indicates that the capsular contracture does not affect the shape, size, or feel of the breast. The breast remains soft to the touch and is considered to be asymptomatic.
Class 2 capsular contracture indicates that only slight cosmetic symptoms are present; the appearance is fairly normal but there is an increased firmness to the touch.
Class 3 capsular contracture indicates distinct cosmetic symptoms but causes little, if any discomfort. The affected breast(s) will appear unnaturally hard and round while the nipple(s) becomes misshapen.
Class 4 capsular contracture indicates significant cosmetic and physical symptoms. The breast(s) will experience the same symptoms from Grade 3, evident breast and nipple distortion, with the addition of physical pain and tenderness.
Capsular contraction typically presents within the first few years after surgery, as the body forms the implant capsules and fully recovers. If late-onset capsular contracture presents, the implants should additionally be checked for ruptures, as it would be the most likely cause.
Capsular contracture treatment options
In very mild cases, capsular contracture may be treated with non-surgical methods such as ultrasound. Cases of grade III and IV capsular contracture are best treated with breast implant revision surgery. I will determine the best course of action to treat the issue and create the desired aesthetic outcome. There are two surgical options recommended to treat Class 3 and Class 4 capsular contracture. A capsulotomy creates more space around the implant by removing and/or opening part of the scar tissue via a small incision at the implant site. A capsulectomy entirely removes the implant and associated scar tissue. Patients may elect to have new implants placed or return to their pre-surgery breast size.
Cosmetic and Reconstructive Breast Surgery in Richmond
If you are seeking a highly-experienced female plastic surgeon who is passionate about informing her patients and takes a sensitive approach to breast surgery, Dr. Sharline Aboutanos would be happy to meet with you. She will listen to your goals and concerns, and empower you by sharing in-depth information about your options. Dr. Aboutanos serves patients from Richmond, VA and the surrounding areas, providing a comprehensive range of cosmetic, reconstructive, pediatric, surgical and non-surgical procedures. To schedule your consultation, contact us online or call our practice at 804.355.3410.