Learn about capsular contracture and its symptoms with Brisbane plastic surgeon, Dr. Phil Richardson. Breast augmentation is one of the most popular cosmetic procedures in the world. At the time of writing this blog post, thousands of women are undergoing the procedure each week globally. While breast augmentation is generally considered less complicated than more involved surgeries such as breast lift, reduction, and revision, there are still risks associated with all types of surgery. Patients should consider post-operative complications, especially those specific to silicone breast implants. 

There have been significant advances in surgical techniques and breast implant technologies over the past decade. These advances have equipped practitioners with the tools to prevent future complications for patients. Despite consistent innovation, there still remain a number of complications that practitioners and patients are constantly navigating and learning about. This blog aims to shed some light on one of the most well-known breast implant complications: capsular contracture.

What is capsular contracture? What are capsular contracture symptoms?

When a patient has a breast augmentation, the body will form a layer of scar tissue around the implant as a response to the foreign object. This will occur for all patients and is a normal aspect of the natural healing process. This layer of scar tissue–“the capsule”–is actually necessary. It helps to hold the breast implant in place and prevent slippage. Issues may arise however if this layer of scar tissue thickens to the point it is compressing and squeezing the implant. This is capsular contracture.

In some cases, if capsular contracture is not bothering the patient, it can be left untreated. In more severe cases however the thickened capsule can cause a feeling of hardness and visible distortion of the breast. This can result in an undesirable aesthetic in one of both breasts. In higher grade cases this may cause pain in the breast/s. Capsular contracture is considered using a grading system called Baker’s Grades. These refer to the number and severity of capsular contracture symptoms. The four levels are as follows:

Grade 1: The normal formulation of scar tissue around the implant. A soft breast that appears natural in size and shape 

Grade 2: The breast is slightly firm to the touch but appears normal. 

Grade 3: The breast is firm to the touch and has a distorted appearance. This is due to the scar tissue squeezing the implant

Grade 4: The breast is hard, has a distorted appearance, and is causing the patient pain

What are the causes of capsular contracture?

Depending on the grade of capsular contracture, this may go undetected. When capsular contracture symptoms begin to present as visible distortion or discomfort, patients may choose to treat the condition. Generally, capsular contracture will develop in the first 2 years post-operatively. More rarely, the condition may develop years down the track. According to the American Society of Plastic Surgeons, ruptured implants are the most common cause of late-onset capsular contracture that occurs years down the track. 

But for the 75% of cases that occur in the first two years, what are the causes of capsular contracture? Opinions differ. Some sources suggest that genetics may play a role in who develops capsular contracture such as family history of autoimmune disease or who have difficulties with medical implants. Other complications that are rare including hematomas and seromas are also believed to increase the risk of capsular contracture by providing a host for bacteria. It is commonly thought that it may be a result of bacterial contamination to the surgical area. This thin layer of bacteria known as “biofilm” develops around an implant during surgery.  As a response to potential low-grade infection, the body will produce more fibrous scar tissue. This could lead to capsular contracture. 

How can you prevent capsular contracture?

There are a number of measures surgeons take to prevent CC. The 14 point plan for surgical practice is a strategy developed to reduce the risk of bacterial infection that is commonly associated with the complication. When you have a consultation with a qualified plastic surgeon (you can read more about the distinction between plastic and cosmetic surgeons here), you should ask them about their adherence to the 14-point plan and the measures they take to prevent post-operative complications. 

Textured Implants

Some surgeons opt for the use of textured implants to prevent capsular contracture. Experts think that the textured surface makes it more difficult for thick scar tissue to develop around the implant. However, in recent years there has been a link discovered between certain textured implant varieties and the development of anaplastic large cell lymphoma (ALCL). For this reason, the majority of plastic surgeons have moved away from textured implants and towards smooth surface varieties. Plastic and reconstructive surgeon Dr. Phil Richardson from Brisbane Plastic & Cosmetic Surgery uses Motiva implants. These nano-textured implants act as a smooth implant in the body while mitigating the risks of ALCL and capsular contracture. You can read more about the implant technology here. 

Implant Placement

Another key method to preventing the complication is submuscular implant placement. According to the American Society of Plastic Surgeons, placing implants under the muscle can significantly lower the risk of capsular contracture. Dr. Phil Richardson recommends sub-muscular or dual plane implant placement for most patients. In some cases, there may be lifestyle or anatomical factors that result in over the muscle placement being more suitable.

How do you treat capsular contracture? 

In cases of Baker Grade 1 (mild capsular contracture symptoms) patients may choose to leave this alone if the condition is not bothering them. Higher baker grades may require treatment. Treatment for capsular contracture has historically involved revision surgery. Revision surgery for capsular contracture involves removal of the breast implant and surrounding capsule and subsequent re-implantation with a new implant. 

Ultimately, the development of capsular contracture is unpredictable. A surgeon can take all the necessary measures to prevent the development of the condition. Yet even still, there may be some uncontrollable variables. Any patient may be susceptible to capsular contracture for a number of reasons. While the condition doesn’t pose direct health risks to the patient, it can cause discomfort. If the scar tissue causes implant rupture this could also result in other complications. Luckily, in recent years implant manufacturers such as Motiva have begun offering warranties for capsular contracture that will cover the cost of the implants and in extended cases help cover hospital fees. This can help alleviate some of the financial strain for patient who develop this rare condition. 

Final Thoughts

If you are experiencing any symptoms you feel may be of concern, we would recommend organising a no out-of-pocket review at a breast implant review service such as the BRAS Clinic in Brisbane. 

If you are aware of your capsular contracture and it has been diagnosed and you are looking towards re-operation with a qualified plastic surgeon, we encourage you to contact Brisbane Plastic & Cosmetic Surgery to organise an initial consultation with Dr. Richardson. Dr. Richardson has performed thousands of revision surgeries over the past decade. He is a voice of authority on breast surgery in Brisbane.