Breast Augmentation comprises a large percentage of my Walnut Creek Plastic Surgery practice. When I see new patients for Breast Augmentation or Breast Augmentation Revision they frequently ask about capsular contracture.
What is the Breast Implant Pocket or Capsule?
Capsular Contracture occurs when the scar that normally forms around a breast implant becomes too much scar. It is normal and desirable that a scar forms around the breast implant. The scar forms a pocket called the capsule. The capsule secures the breast implant and keeps it from migrating around under the skin. The capsule is very important to prevent malposition and bottoming-out of the breast implants. A normal capsule is soft and cannot usually be felt.
What is Capsular Contracture?
Capsular Contracture occurs when the capsule is too tight or too thick. While Wikipedia defines capsular contracture as an abnormal response of the immune system, it is more likely an exaggerated normal response. If the capsule is tight all around the breast implant, it can make the breasts feel hard and immobile. If the capsule is tight on just one side, it can push the implant. For example, when the scar is tight on the bottom, it moves the implant up. The result is the opposite of bottoming out.
Baker’s Grades of Capsular Contracture
Capsular Contracture is graded (Baker grades) as follows:
- Grade I – Naturally soft. Not palpable
- Grade II – Increased firmness. Scar is palpable. No visual distortion.
- Grade III – Firm to touch. Immobile causing visual distortion.
- Grade IV – Same as Grade III and painful.
Grades I and II are the most frequently seen capsular contractures and are not normally treated. Grades III and IV are less frequent, and are often treated with a Breast Augmentation Revision Surgery.
Capsular Contracture Treatment
Many non-operative treatments exist and none have been proven to be clinically effective. Massage, ultrasound, vitamin-E, antibiotics, steroids and the latest leukotriene inhibitors (Accolate) have been tried with occasional anecdotal improvement, but there are no large studies proving any of these techniques safe and effective for treating capsular contracture. They are frequently employed with grade II and early grade III capsular contracture in an attempt to reverse the progression to a tighter scar capsule.
The best method of treatment remains breast implant revision surgery. For grade III and IV capsular contractures, capsulotomy and capsulectomy are the mainstay of treatment. Capsulotomy is a surgical technique during which the capsule is incised to allow for expansion. This is most effective when the scar is thin and soft. Capsulectomy is the surgical removal of the scar. This is used when the scar is thick. There is a slightly greater risk of bleeding with the capsulectomy.
More Information about Capsular Contracture is Available Here
Additional articles about Capsular Contracture are available here on the San Francisco Plastic Surgery Blog. Just click these links: