What is Capsular Contracture and How Can I Avoid it?

Most patients considering undergoing a breast augmentation will likely come across the term “capsular contracture” in their research. A known complication of breast augmentation, capsular contracture is basically a painful and hard breast that can result after a breast surgery or after a trauma. Below we go over what exactly causes a capsular contracture and what patients can do after surgery to avoid it.

What is Capsular Contracture?

Once a breast implant is in place, fibrous scar tissue naturally forms around it, creating a tissue capsule. This tissue capsule is usually soft or slightly firm, not noticeable, and helps to keep the implant in place. The formation of this capsule is a normal part of the healing process.

In some women, the tissue capsule that forms around the implant becomes hard and dense, tightening around the implant and squeezing it. This condition, called capsular contracture, can cause chronic pain and distorts the shape of the breast.

What Causes It?

Capsular contracture usually results from the formation of a hematoma around the breast implant. A hematoma is simply a pool of clotted blood. Hematomas can form after the body receives some type of trauma, such as a car accident, or be caused by the trauma of the breast augmentation surgery itself. This means that even if you heal well and without complication after your breast augmentation, you could develop capsular contracture at a later time if you experience an injury. About 75 percent of the time, however, capsular contracture occurs within the first two years after surgery.

Genetics may also affect your risk of capsular contracture. People with autoimmune diseases or whose family members tend to develop thick scars after surgery may be more likely to experience capsular contracture. Researchers also believe that something called biofilm may be to blame. It’s now believed that in some cases, capsular contracture occurs when staph bacteria is somehow introduced to the surgical site during a breast augmentation. As the staph bacteria grow, they produce a layer of biofilm over the implant. As the body fights off the bacteria, scar tissue forms and ultimately causes a capsular contracture.

Note that this theory does not suggest a failure on the part of the surgical team. As the American Society of Plastic Surgeons explains, “Some people are natural carriers of staph bacteria; it’s always present on their skin and usually causes no symptoms. Only when these individuals have their skin penetrated does this bacterium have a chance to cause any serious issues.” Hospitals and clinics work hard to avoid staph infections, but completely eliminating every trace of this common bacteria isn’t always possible.

How Common is Capsular Contracture?

Capsular contracture is the most common complication after breast augmentation surgery, but luckily it only occurs in about 10.6% of patients. While they can be very uncomfortable, capsular contractures are not life-threatening and corrective surgery can fix the issue if necessary.

If the contracture is mild, it may not cause any pain or breast distortion. In this case, many women choose to do nothing about the condition. Others find that Vitamin E supplements can help soften the scar tissue, easing the pain of a mild contracture without surgical intervention. If your issue is mild, talk to your surgeon about all of your treatment options. Corrective surgery is always a choice but isn’t always required.

Can It Be Avoided? Precautions to Take

While there are certain events that are out of a patient’s control when it comes to avoiding capsular contractures, such as a car accident or other form of trauma, there are also many preventative measures that you can take to avoid this complication. At Mia Aesthetics, we use clean and careful surgical techniques to minimize the risk of bacterial infection. We also give our patients clear and specific post-operative instructions and encourage the use of compression garments.

Capsular contracture is also less common when the breast implant is placed beneath the muscle, but this is an option you’ll need to discuss with your surgical coordinator during your free virtual consultation. Surgeons and researchers have also found that Singulair and other similar asthma medications can reduce the risk of capsular contracture.

Why Does Singulair Help Resolve Capsular Contracture?

When your body comes into contact with something it doesn’t like, such as an allergen, it produces substances known as leukotrienes. These leukotrienes cause inflammation in your airways, causing you to cough, wheeze, and have difficulty breathing. This can aggravate asthma and cause breathing problems. Medications like Singulair work as leukotriene antagonists, slowing your body’s production of leukotrienes while simultaneously blocking receptors in your body from absorbing them.

Scientists have discovered that leukotrienes are present in those with asthma and also in patients who experience capsular contracture. Although not yet approved by the FDA for this particular use, several researchers and Mia Aesthetics’ own Dr. David Gray have had great success using these asthma medications to prevent capsular contracture.

How Serious is Capsular Contracture?

Although not a life-threatening complication, capsular contracture is taken quite seriously by plastic surgeons. For many the condition is quite painful and as such is not dismissed or taken lightly. Capsular contracture can also cause cosmetic issues when it misshapes the implant. Fortunately, capsular contracture can always be corrected, although correction does sometimes require surgery. During a corrective surgery, your surgeon will perform one of several techniques to resolve your capsular contracture. In some cases, the surgeon will completely remove your breast implant and the capsule of scar tissue surrounding it. He will then insert a new implant that is surrounded by collagen and less likely to cause future scarring. In other cases, your surgeon may make incisions in the capsule surrounding your implant while removing sections of it. The hope is to loosen the capsule enough that the breast implant can move around within it, reversing any distortion and alleviating pain.

Surgeons also have the option of removing the offending breast implant and capsule and replacing them with a skin flap from another part of your body. This procedure ensures that your capsular contracture won’t return, but it is a complicated surgery with a longer recovery time than other capsular contracture repair methods.

What are the Symptoms? Any Early Warning Signs?

Unfortunately, capsular contracture doesn’t come with a lot of early warning signs. It typically starts with a tightening feeling in the chest that sometimes gets progressively worse. Signs include swelling in the chest and a breast that is firm or hard to the touch. Your breast will possibly become misshapen and may look as though there is a ball inside of it. Your implant may look as though it is sitting too high, and you may experience pain and tenderness in your breast.

In Conclusion

While a capsular contracture is a known complication of breast surgery, it is not life-threatening and can be corrected with surgery if needed. The best ways to avoid capsular contracture are to follow all post-op instructions, wear your compression garment as directed, and choose a reputable plastic surgeon with years of experience in breast procedures.

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