Capsular Contracture of the Breast: What is it?
Capsular Contracture or Capsular Contraction”, is a condition that may affect those who undergo breast augmentation, either electively or after breast reconstruction. It is a hardening and constriction of the breast implant capsule and causes breast firmness. In the most severe cases, it can create a painful, distorted, misshaped, or oddly positioned implant.
The truth is that a capsule is natural, and forms around any foreign object in our bodies, in this case, the breast implant. This “capsule” or implant shell is similar to the thin opaque membrane that one may see when you break open a hard boiled egg. It’s the flimsy/ rubbery covering inside the shell but outside covering of the egg.
A capsule normally occurs to anything “foreign” object inside the body, like hip replacement prosthesis, metal fragments, or even a thorn deeply lodged inside the body. It becomes a problem, when the natural capsule is triggered to constrict or fibrose, which ultimately causes hardening of the breast implant shell and possibly other problems.
Causes and Signs of Capsular Contracture
- Bacterial Infection
- Hematoma (Excessive blood that collects in an area)
- Seroma (Non-blood type watery liquid that collects in an area)
- Radiation treatment for breast cancer
- Capsular Contracture firmness is graded using the Baker Grading System:
- Grade I: Breast looks and feels normal
- Grade II: Breast feels a little firm but looks normal
- Grade III: Breast is more firm and is visually distorted (shape change or mal-positioned)
- Grade IV: Breast is hard and greatly distorted in shape and position
- IMPLANT NOT DROPPING OR IN HIGH POSITION
- DISTORTED SHAPE OR APPEARANCE
Antibiotics, Papaverine, ANTI-inflammatories, or even Vitamin E may be recommended after surgery. It important to discuss this with your surgeon as these substances are not always indicated and may have possible adverse side effects. Antibiotics may be especially important for future dental procedure as it may help prevent a late onset of contracture from possible infection.
MEDICATIONS like Accolate or Singulair, which are anti-asthma drugs, have shown some promise. They actively reduce the inflammatory process in Asthma and have shown some benefit to helping prevent, even soften, already contracted implants. Using these medications for the purpose of Capsular Contracture is considered an off-label use so it is very important to speak with your surgeon if these medications are right for you.
CAPSULE SURGERY, often known as open capsulectomy or capsulotomy, can be done to release, cut, and allow for opening of the contracture. The goal is to release the tightness and allow for return of softness. An alternate method is called a closed capsulotomy. This is where the surgeon physically breaks the capsule forcibly by squeezing the breast from the outside to allow for release and softening. This method is not widely used as it is painful, voids the implant warranty, may create instability in the position of the implant, and may compromise the implant itself. It is also worth mentioning that both the above open and closed capsulotomy procedures may result in a repeated contracture occurring, so discuss the best option with your surgeon.