Capsular Contracture

Any implant placed in the body will induce the formation of a thin protective scar layer commonly termed a capsule. This is the body’s response to something foreign and primarily serves to protect the body from whatever that “foreign” item is. This occurs in pacemakers, joint replacements, breast implants, and even something like glass in your leg for example. The difference with breast implants is that they are the only soft and supple implant that needs to remain that way to adequately do their job.

capsular contracture breast implantsIn rare instances, the capsule can begin to contract. In an implant made of solid silicone or stainless steel, for example, there is no way for the capsule to deform that type of implant. However, with soft silicone gel implants it is by design that they are easily deformable and the capsule can alter the shape of the implant if it contracts. This can leave a patient with a misshapen or harder breast implant that may look different than the other side and can even be associated with pain. If this were to occur in something such as a knee replacement, for example, physical therapy can break through the scar tissue and correct this. However, this is impossible with breast implants.

Unfortunately, the cause or reason for this is largely unknown. Numerous studies have been performed to determine why this happens in breast augmentation patients, and none of these has been able to conclusively determine why this contraction happens. Keep in mind that the presence of a capsule is normal but the contracture is the problem.

Because we are unsure of the exact cause, there are numerous treatment possibilities. Some physicians may elect to use an anti-inflammatory asthma medication called Singulair to attempt to soften the capsule. This has been shown to be successful in 10 to 15% of patients. Some doctors prefer to treat this surgically. The simplest approach is to open up the breast capsule and make internal cuts into the capsule to allow it to expand – thereby releasing the capsule. This allows the implant to sit more naturally on the chest and is returned to its proper shape and position. However, this has also found to be limited in its long-term success. Unfortunately, patients frequently have a recurrence of the contracture soon after this procedure is performed. There are instances where this will correct the problem but it is less frequently seen.

The next more definitive and successful approach is to remove the entire contracted capsule and the old implant. The patient will receive a brand new implant in normally the same position of the old contracted capsule. If the implant is located in the subglandular position, frequently this will be replaced in a submuscular position since the rates of capsular contracture are much lower. This has been much more successful in definitively correcting the contracture.

Here is a video of a patient who had a bilateral capsular contracture and underwent the complete removal of the capsule and the replacement of new implants in the submuscular position. This can help demonstrate how the narrow capsule can constrict the gel implant thus changing its shape in the body.

About the Author:

Dr. Vince Marin is a San Diego board-certified plastic surgeon specializes in cosmetic surgery of the face, nose, breast and body. If you wish to contact Dr. Marin, write to [email protected] or you can follow him on Twitter!