If you’re considering breast augmentation surgery, it’s always a good idea to familiarize yourself with the potential complications. Most surgeries are complication-free, but the risk of complications is worth considering and understanding. By understanding potential risks in advance, you can make a more informed and confident decision about your treatment plan.
Among the most common breast augmentation complications is capsular contracture, which can change the appearance of the breast and cause pain. Here’s our overview of the potential risk — what it is, why and where it occurs and how to fix it.
What Is Capsular Contracture?
Breast augmentation consists of the insertion of a foreign body, most commonly an implant filled with silicone gel, into the breasts to enhance their appearance. The body’s natural reaction to the insertion of a breast implant or any other foreign body is to form scar tissue, which is completely normal and plastic surgeons refer to as the capsule.
In some cases, however, the capsule can over-develop. This means that the scar tissue tightens and hardens, which constricts the breast implant and may make it tight, painful, or misshapen. This tightening and hardening is known as capsular contracture.
Incidence rates of capsular contracture can vary widely from surgeon to surgeon, but different studies have reported it occurring in 2.8 – 20.4 percent of breast augmentation procedures. Although it can occur at any point after the operation, approximately 75 percent of cases occur within two years of surgery.
Capsular contracture varies not only in its time of onset but also in its severity. It comes in various grades, from I to IV, depending on the extent of the symptoms. Grades III and IV are considered severe and usually require surgical revision. The lower grades usually are quite unnoticeable and may not need any treatment.
Why Does It Occur?
The exact cause of capsular contracture is unknown, and the condition is mostly unpredictable. There are, however, several known risk factors that can increase its likelihood.
Many risk factors have to do with a patient’s history, while others are related to the surgery itself.
On the patient side, lifestyle choices such as smoking can increase the risk of capsular contracture. Other relevant factors include autoimmune disorders, breast trauma and previous exposure to radiation. Talking with your surgeon can help you better understand how your health and history might influence your risk.
Factors related to the surgery itself, on the other hand, can also affect your chances of experiencing capsular contracture. For example, complications like infections and blood vessel damage are known risk factors. Furthermore, the use of an implant that is too large for your skin may also increase the likelihood of capsular contracture.
Where Does It Occur?
Capsular contracture occurs in the area immediately surrounding the breast implant, and it stems from the normal function of the human immune system. It’s expected for the body to form scar tissue, or a capsule, around a foreign body. However, whether it’s caused by one of the risk factors above or a different reason, the capsule can sometimes contract, meaning that it over-develops, tightens and hardens.
The reason capsular contracture occurs is unknown. Some researchers propose that breast augmentation surgery causes inflammation, or that a small amount of blood leaked into the cavity may cause an increase in the scar around the implant. Others propose that it is the result of a mild infection. But these ideas are still unconfirmed.
How to Fix It
While the cause of capsular contracture is not well-understood, there are effective ways to treat it once it occurs. There are even several breast augmentation methods currently in use that may reduce the risk of its onset.
The precise placement of the implant, for example, can influence risk. Implants that are placed under the pectoral muscles are less likely to result in capsular contracture than those placed above the muscles. Textured implants were initially thought to reduce capsular contracture risk because their rough surfaces would deter scar cells from lining up. This, however, has not been proven true in more recent studies. In fact, smooth implants generally are thought to be softer and to stay that way. One final example of a surgical method thought to reduce risk is the “no-touch” technique, during which the surgeon takes careful measures to ensure that the implant is never exposed to bacteria in the air or on your skin. Ask your surgeon about the surgical techniques he or she uses to decrease your risk of capsular contracture.
Keep in mind that a mild capsular contracture is not harmful to your health and that treating a contracture is always elective. For treating severe capsular contracture once it appears, however, surgery is almost always the best option. The goal of capsular contracture surgery, known as a capsulectomy, is to remove the problematic capsule. In general, capsulectomies are relatively fast and easy procedures that include going back through the same incision, temporarily removing the implant and removing the areas of scar inside that are symptomatic. The implant will then be replaced.
When having a capsulectomy and choosing to have the implant replaced, it’s important to understand that breast implant replacement surgery comes with the risk of another possible capsular contracture. The best way to decide whether to have your implant replaced after capsular contracture surgery is to discuss your specific situation with your surgeon.
The risk of capsular contracture isn’t a very high risk, nonetheless, it’s a good idea to become familiar with the potential for complications so you can set appropriate expectations for your treatment. Plus, there are steps you and your surgeon can take to reduce your risk.
You can use the information in this guide to form questions for your next breast augmentation consultation.