What is Capsular Contracture and How Can It Be Treated

Breast augmentation is one of the most popular cosmetic procedures worldwide, but even with advanced techniques, complications like capsular contracture affect a significant number of patients. Still, it’s important to understand potential complications associated with breast implants. Among these, capsular contracture—a hardening or tightening of the scar tissue (capsule) surrounding the implant—remains one of the more commonly cited reasons for revision surgery.

In this blog, Dr Turner Specialist Plastic Surgeon will explain what capsular contracture is, how it might be prevented, and how it can be treated. Allowing you to recognize early changes associated with capsular contraction and seek effective interventions if occurs.

What Is Capsular Contracture?

Any medical device inserted into the body, whether it is a hip joint, pacemaker or a breast implant, leads to the body creating a capsule of thin layer of scar tissue around it. This capsule usually stays soft and flexible, holding the implant securely and allowing the breasts to feel natural.

However, capsular contracture occurs when this scar capsule tightens, thickens, or becomes abnormally firm. Capsular contracture can happen in one or both breasts and frequently varies in severity. In more advanced stages, breast implant revision surgery is required to restore normal breast aesthetics and alleviate discomfort.

Signs to look out for include:

• Increased Firmness: The breast that once felt soft begins to feel harder or less mobile.
• Altered Shape or Position: Implants may shift upward, look more rounded, or become misshapen.
• Discomfort or Pain: As the capsule tightens, it can cause tenderness, pain, or a sense of pressure.
• Visible Distortion: More advanced contracture can result in noticeably distorted breast contours.

Causes and Risk Factors

The precise cause of capsular contracture isn’t fully understood, but it’s commonly linked to inflammation and the body’s healing process. Several factors can play a role:

• Biofilm: Low-level bacterial contamination around the implant can keep the immune system in a state of ongoing inflammation. This can encourage the capsule to thicken and contract over time.
• Hematoma or Seroma: Fluid collections – blood or serous around the implant can increase inflammation and infection risks, potentially leading to abnormal scar formation.
• Smoking: Nicotine in cigarettes and vapes impair blood flow and healing, raising the likelihood of thickened scar tissue.
• Radiation Therapy: Radiation treatments to the chest area alter tissue quality and may increase the risk of contracture.
• Genetic Predispositions: Some individuals naturally form more fibrous scar tissue, making them more prone to contracture.

Classification of Capsular Contracture

Doctors often classify capsular contracture using the Baker Grading Scale:

• Baker Grade I: Soft and natural appearance.
• Baker Grade II: Slight firmness but normal appearance.
• Baker Grade III: Firmness and visible distortion.
• Baker Grade IV: Hard, painful, and clearly distorted.

Understanding the severity of capsular contracture helps in determining the best ways to prevent and manage it.

Preventative Measures

While capsular contracture cannot be eliminated completely in breast augmentation surgery, there are modern surgical techniques which can significantly reduce the risk. One widely accepted strategy by plastic surgeons internationally is to minimize bacterial contamination and inflammation around the implant by following a rigorous protocol known as the “14 Point Plan”. This helps to minimise the development of bacterial biofilm during breast implant surgery.

14-Point Plan to Reduce Biofilm and Lower Capsular Contracture Risks:

1. Administer intravenous antibiotics at the time of anaesthetic induction.
2. Avoid peri-areolar incisions.
3. Use nipple shields to prevent spillage of bacteria into the pocket.
4. Perform careful atraumatic dissection to minimize obstruction of blood vessels.
5. Perform careful haemostasis (minimise bleeding).
6. Avoid dissection into the breast parenchyma. The use of a dual plane, subfascial pocket has anatomic advantages.
7. Use a dual-plane pocket or subpectoral pocket.
8. Perform pocket irrigation with correct proven triple antibiotic solution or betadine.
9. Minimise skin-implant contamination.
10. Minimise the time of implant opening, reposition and replacement of implant.
11. Change surgical gloves prior to handling the implant. Use clean or new instruments that were not used in the pocket dissection.
12. Avoid using a drainage tube, where possible.
13. Use a layered closure.
14. Use antibiotic prophylaxis to cover subsequent dental or surgical procedures that produce bacteraemia and have lifelong follow-up.

Non-Surgical Treatment Options

Non-surgical options aim to slow capsular contracture in its early stages. However, these methods are unproven and often ineffective in advanced cases. Surgical treatment is the definitive solution for advanced capsular contracture.

Medications

Anti-inflammatory medications are sometimes recommended to slow scar thickening in early cases of capsular contracture. While these drugs may provide some benefit, the evidence supporting their effectiveness is mixed, and they are not yet standard practice. Ongoing research is needed to determine their role in managing capsular contracture, as their impact appears to be limited to mild cases and early intervention.

Ultrasound Therapy

Ultrasound has been suggested as potential non-surgical options for addressing capsular contracture in its early stages. These techniques aim to improve circulation and soften the capsule by relaxing the tight scar tissue. While some preliminary studies show promise, this approach remains investigational and has not yet been proven to offer consistent or significant results.

Closed Capsulotomy

Involves manually manipulating the breast to break the scar tissue surrounding the implant. This technique is not widely favoured due to its limited success, high recurrence rates, and risks such as implant rupture and hematoma formation.

Surgical Treatments for Capsular Contracture

When capsular contracture becomes pronounced (Baker grade III or IV), surgical intervention is often the most effective treatment. Below are the common surgical options, tailored based on the severity, implant type, and individual anatomy:

Capsulotomy

A capsulotomy involves making incisions in the scar capsule to release tightness and alleviate pressure on the implant. This method maintains the existing capsule while creating additional space around the implant. However, while it can provide symptom relief, capsulotomy does not remove the scar tissue entirely. As a result, early recurrence is common, especially in severe cases of capsular contracture.

Capsulectomy

Capsulectomy is the surgical removal of part or all of the scar capsule surrounding the implant. This procedure allows the surgeon to “reset” the implant pocket, providing a cleaner environment for the implant. Total capsulectomy is often preferred in severe cases as it provides a more definitive correction and reduces the risk of recurrence.

Implant Exchange or Repositioning

Capsular contracture frequently occurs with older implants, requiring their replacement. Replacement often involves switching to a different type of implant, such as moving from smooth to textured implants or opting for implants with a smaller profile. Two key techniques are commonly used:

• Pocket Change: Repositioning the implants into a new pocket, such as transitioning from a subglandular (above the muscle) to a dual-plane or submuscular position reduces the recurrence and improves breast aesthetics.
• Neopocket Formation: Creating a new pocket between the old capsule and the overlying pectoralis muscle while leaving the new breast implant in the same dual-plane or submuscular position. The old pocket is collapsed and secured to the chest wall, decreasing the risks associated with total capsulectomy and enhancing the stability of the new implant position.

Fat Grafting

For patients who have experienced multiple recurrences or those who prefer not to have implants, fat grafting is an alternative solution. This technique involves removing the implants and replacing volume with the patient’s own fat, harvested through liposuction. Fat grafting is typically performed over two procedures to ensure adequate volume and optimal contouring.

Long-Term Outlook and Recurrence

While surgical correction can effectively address capsular contracture, recurrence remains a possibility. Prevention strategies, including the 14 Point Plan and diligent postoperative care play a vital role in reducing the likelihood of recurrence.

Importance of Early Detection

Regular self-examinations and routine medical check-ups are critical for early detection. Timely intervention can prevent extensive surgeries and maintain natural breast contours.

Risk of Recurrence After Revision Surgery

Recurrence rates after breast implant revision surgery have been reported anywhere from about 15% up to 30% over the following 1-2 years. This risk can lead to repeated revision surgeries, with recurrence rates remaining high even after multiple interventions.

Next Steps

By understanding what capsular contracture is, being vigilant about symptoms, and seeking timely professional guidance if concerns arise, you set the stage for a smoother experience, whether you’re considering your first breast augmentation or managing implants you’ve had for years.

Contact our clinic today to schedule your consultation with Dr Turner and take the first step towards achieving your aesthetic aspirations.

1. Schedule a Consultation: Contact us at 1300 437758 or visit drturner.com.au to book your appointment.
2. Prepare for Surgery: Follow any preoperative guidelines provided, such as avoiding certain medications and arranging for post-surgery care.
3. Plan for Recovery: Set aside time for rest and healing and arrange for assistance during your initial recovery phase if needed.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Consult with a qualified healthcare professional to determine the best treatment options for your individual needs. A formal quote will be provided after your consultation with Dr Turner that gives a better estimate of costs involved in your planned procedure.