What is Capsular Contracture?

The “capsule” refers to the lining that your body forms around a breast implant. This is the body’s way of protecting itself against a foreign body. This capsule, or pocket, is formed during the healing process, and remains as fibrous tissue similar to a scar. Capsular contracture is a shrinking and tightening of this capsule, putting pressure on the implant. The implant may become very firm and the its appearance may become altered.

You should be aware that the implant itself is not malformed or dysfunctional – it is the capsule that is squeezing the implant and causing it to look unnatural.

While there is no clear-cut cause identified for capsular contracture, there are certain risk factors that have been identified, and ways you can minimize your chances of its occurrence.

Minimizing the risk of capsular contracture

The first and most important measure to take to prevent all post-surgical complications is care over preventing infection. The body has enough to handle in its recovery from any surgery. Capsular contraction is a form of defense on the body’s part, akin to fighting infection, insofar as it perceives the implant as a foreign body, and seals it off. So to minimize the “insult” of surgery (from the body’s perspective), keep your incision area scrupulously clean.

In addition, these measures may help prevent capsular contraction, although there is no proof that they will always do so in every case:

· Use of textured breast implants rather than smooth-surfaced implants

· Placement of the implants under the muscle (sub-pectoral) as opposed to over the muscle. This causes the muscle, when you use it, to massage the implant, which helps against contracture. It also keeps the implant away from the milk ducts, which contain bacteria.

· Use of Vitamin E, but not until about two weeks after surgery, as Vitamin E can affect the blood’s clotting ability. Some medical professionals feel that it can soften the fibrous strands that make up the capsule.

· Massaging the implant after surgery

· Wearing a compression bra and doing compression exercises. Compression helps to keep the capsule open.

· Refraining from smoking, as nicotine contracts blood vessels, slowing down your healing, making it more of a project for your body.

Treatment for Capsular Contracture

Capsular contracture is not permanent – it can be treated using surgical and nonsurgical options.

· Open capsulotomy: The surgeon will make an inconspicuous incision and then cut the scar tissue in order to release the pressure put on the implant.

· Open capsulectomy: The surgeon surgically removes the entire scar capsule, allowing your body to reform a healthy new capsule. This is the usual choice and the most successful.

· Closed capsulotomy: A nonsurgical option in which the surgeon will squeeze the implant in an attempt to rupture the capsule. This is not done often, as it has a low success rate.

· External ultrasound is a nonsurgical option that helps reduce swelling and inflammation, and promotes healing. It is used both for prevention and treatment.

· Antibiotics are sometimes given to treat contracture, but seem only to be effective against swelling and pain.

· Accolate, an Asthma drug, has shown some success in reversing capsular contractures in the early stage, and in reducing inflammation. The FDA has not approved Accolate for this use, and it’s known as “off-label” use.

The bottom line is that while capsular contraction is a potential complication of breast augmentation surgery, finding a surgical center who gives you all the pertinent information before hand and does everything possible to minimize your risk should be your first priority. If you experience any negative side effects following your breast augmentation, such as firming of the implant, soreness, distorted shape, or pain, contact your cosmetic surgeon immediately.

Normal healing vs. hardening

Your body’s natural response to breast implants is to form a protective lining around them, called a capsule. This is a good thing, and helps keep them in exactly where you want them.

If that protective lining tightens or thickens, it’s called capsular contracture. It makes your breast hard, and it can distort its shape. It can also be very painful.

Why some breasts harden and some do not

Doctors don’t know for sure why some women experience capsular contracture and others never have a problem, but they have narrowed it down to some risk factors including:

· Autoimmune disorders

· Smoking

· Radiation therapy

· Severe trauma to the breast

· Hematoma

· Seroma

· Bacteria and infections

· Silicone molecules leaching into the capsule

Reducing your risk for capsular contracture

There are some choices you can make regarding your implants and the type of surgery you have, and some things that you can do at home which may help to prevent the problem.

· Massage and exercises after your surgery

Ask your cosmetic surgeon about massage techniques, pocket quadrant exercises, and compression exercises you can use at home to keep your breasts soft and the capsule flexible.

· Vitamin E

Taking Vitamin E can speed healing, reduce scaring, and help keep the capsule soft. It can also increase bleeding and shouldn’t be started right away. Ask your cosmetic surgeon when you should begin taking it and how much will be safe and effective for you.

· Implant type, texture, and placement

Choosing saline implants, implants with a textured surface, and placing implants behind the muscle can all reduce the chance of hardening. None of these choices should be based on the risk of capsular contracture alone.

· “No touch” surgery

The no touch technique is used to prevent even the smallest amount of bacteria getting in and being sealed in with your implant. Once the pocket is made it is washed out and coated in an antibiotic solution and everything, including the gloves your surgeon wears, the instruments, and the implant itself, that touches you after that is coated in the solution as well.

Most women who choose breast augmentation never have a problem. Even if you are considering a second breast enlargement surgery and experienced capsular contracture before, it does not mean you will experience it this time around.