A Closer Look at Capsular Contracture

A Closer Look at Capsular Contracture

Capsular contracture is one of the most common breast surgery complications, with an incident rate between 8 and 15 percent, according to a 2016 literature review published in the International Journal of Surgery Open. It can occur after both breast augmentation and reconstruction surgery, causing an unnatural firmness and abnormal appearance in the breasts. While it often begins within months after surgery, it can occur at any time. Even after treatment, capsular contracture can reappear.

This adverse outcome has complicated breast augmentation and reconstruction since the first surgeries. Plastic surgeons and other health care professionals should have a solid understanding of the complication and its prevention methods in an effort to reduce the cases of capsular contracture.

Plastic surgeon discussing breast augmentation with patientCapsular contraction is a possible complication of breast augmentation surgery.

What are the signs of capsular contracture?
If breasts begin to look or feel different after surgery, it could be capsular contracture. It develops when internal scar tissue forms a tight capsule around breast implants. As the tissue continue to tighten, it causes the breast to become hardened and misshapen.

As firmness increases, the breasts may begin to feel tender and painful, especially when lying on them. They may start to look very round and visible rippling might begin to show. As it progresses, it can distort the breast shape. These signs can occur in one or both implants.

Are there different variants?
There are four levels of capsular contracture, according to the U.S. Food and Drug Administration. They are based on perceived appearance, firmness and pain in the breast, and ranked on the Baker Grading Scale:

  • Grade I: Breast is soft, looks natural in size and shape
  • Grade II: Breast is a little firm, looks normal
  • Grade III: Breast is firm, looks abnormal
  • Grade IV: Breast is hard, painful to the touch, looks abnormal

Some severe cases of capsular contracture can also cause the breast implants to shift out of place or rupture. While most occurrences are treated on a patient by patient basis, women who experience Grade IV typically need implant removal surgery.

What causes the complication?
There are no known causes for capsular contracture, but research has identified potential risk factors. A 2015 literature review published in the Archives of Plastic Surgery concluded that smooth implants, placed in a subglandular position appeared to have the biggest risk of developing capsular contracture.

A 2017 study published in the Journal of the American Society of Plastic Surgeons identified additional risk factors. Across four cohorts in 17,656 participants, capsular contracture occurred in 2.3 to 4.1 percent of implants.The researchers reported subglandular placement of the device, older device age and periareolar incision site were significantly associated with capsular contracture risk. They also found older subject age and higher body mass index levels contributed to risk in some cases.

What are the treatment options?
With such diverse and multifactorial cases, universal treatment options are relatively limited. In the most cases, surgery to remove the implants and surrounding scar tissue is the best cure. While the aesthetic results aren’t as preferable, it’s the only way to ensure the condition won’t return. Some patients opt for reimplantation surgery after the removal. If they do, surgeons must warn them that there is an increased risk of capsular contracture occurring again after the second implant.

Plastic surgeon with patientPlastic surgeons can prevent capsular contracture by minimizing contamination and bacterial access during the operation.

Can it be prevented?
For less severe Grade I and II cases, certain massages can be beneficial for soothing the tissue before it hardens. Plastic surgeons offer different recommendations for how often and how long, but most typically agree that regular breast massages can be an effective way to prevent capsular contracture.

Many doctors also believe reducing the amount of contaminants during operations is beneficial during any surgery. In a recent analysis published in Gland Surgery, the authors offered this as a capsular contracture prevention method. They concluded careful pre-operative efforts, such as thorough skin cleaning with an antibacterial cleanser, can minimize contamination and reduce bacterial access during surgery.

The immune system will naturally respond to the foreign materials, which might be why the scar tissue develops when capsular contracture occurs. It’s important for surgeons to use meticulous techniques and careful procedures to reduce the possibility of bacteria entering the implants. The ONETRAC Single-Use Surgical Retractor is a ready-to-use device from OBP Medical that helps reduce the risk of cross-contamination in breast and reconstructive procedures. With an integrated LED source, it also helps illuminate surgical tissue pockets and cavities. Request a free sample today.

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