Capsular contracture occurs when the scar tissue that normally forms around a breast implant tightens. The breast may feel firmer, change shape, or become painful. Mild firmness does not always require treatment, but a new or worsening change should be evaluated by a plastic surgeon.
Why Does a Capsule Form Around an Implant?
Breast implants have a silicone outer shell filled with either saline or silicone gel. After an implant is placed, the body naturally forms a layer of scar tissue around it called a capsule. This is a normal part of healing. Capsular contracture occurs when that tissue tightens around the implant, sometimes making the breast feel firm or changing its shape.
What Are the Signs of Capsular Contracture?
Surgeons commonly describe capsular contracture using 4 Baker grades:
- Grade I: The breast feels soft and looks natural.
- Grade II: The breast feels somewhat firm but looks normal.
- Grade III: The breast feels firm and looks different.
- Grade IV: The breast feels hard, looks different, and is painful.
Grades III and IV are considered more severe and may require surgery. A surgeon can assess whether contracture or another issue is responsible for a change in your breast.
In this video, board-certified plastic surgeon Dr. Jeffrey Roth explains how the body forms a capsule around a breast implant and what happens when that tissue tightens. He also discusses capsulotomy and capsulectomy as possible treatments for capsular contracture.
How Is Capsular Contracture Treated?
Treatment depends on your symptoms, the condition of the implant, your health, and whether you want to keep your implants. A mild case that is not causing discomfort may be monitored. When firmness, pain, or changes in breast shape are significant, Dr. Roth may discuss breast augmentation revision.
Surgical options may include:
- Releasing part of the tight capsule (open capsulotomy)
- Removing part or all of it (partial or total capsulectomy)
- Removing or replacing the implant
The appropriate approach varies by patient. In some revision procedures, Dr. Roth may also consider placing the implant in a different pocket or using acellular dermal matrix (ADM), a material that can provide added tissue support. These approaches may help reduce the chance of contracture returning in selected patients. It’s important to note that no treatment guarantees that capsular contracture will not recur.
What Is a Capsulectomy?
A capsulectomy is a surgical procedure to remove scar tissue around a breast implant. A partial capsulectomy removes some of the capsule; a total capsulectomy removes all of it. The surgeon may also remove or replace the implant, depending on its condition and the patient’s goals.
The choice depends on the severity and location of the contracture, the condition of the implant, and the risks of removing the capsule. Dr. Roth can explain which approach is appropriate after examining the breast.
Special Cases for Capsulectomy
In some cases, there may be additional considerations for capsulectomy procedures. For example, patients who have experienced implant rupture or leakage may require special attention during the removal of the capsule. Additionally, patients with a history of breast implant-related infections or complications may require a more specific approach to their capsulectomy procedure. It is crucial for patients to disclose their complete medical history and any previous breast surgery experiences to their surgeon to ensure appropriate treatment planning.
What Is Capsulotomy?
An open capsulotomy is a surgical procedure to cut and release a tight capsule without removing all of it. It may be an option when capsular contracture causes firmness, discomfort, or a change in breast shape, but removing the entire capsule is not necessary. Mild cases that are not bothersome may instead be monitored. Dr. Roth will consider the severity of the contracture, the condition of the implant, and your goals when comparing capsulotomy with capsulectomy. Contracture can return after either procedure.
Special Considerations
Patient anatomy and its influence on procedure choice
Every patient has unique breast anatomy, and this plays a significant role in determining the appropriate capsular contracture treatment. The size, shape, position of the implants, and the thickness of the capsule can vary between individuals. Surgeons must carefully assess each patient’s anatomy to choose the most suitable surgical technique and achieve the desired outcome while minimizing the risk of complications or unsatisfactory results.
Complications and risks of capsular contracture treatment
As with any surgical procedure, capsular contracture treatment carries certain risks and potential complications. These can include infection, bleeding, poor wound healing, changes in breast sensation, implant malposition, implant rupture, and the recurrence of capsular contracture. It is important for patients to discuss these potential risks with their surgeon and follow all pre- and post-operative instructions to minimize the chances of complications.
Is Capsular Contracture the Same as Breast Implant Illness?
No. Capsular contracture involves the tightening of the tissue around an implant. Breast implant illness (BII) is a term some patients use for symptoms such as fatigue, difficulty concentrating, and joint pain. Some patients report improvement after implant removal, but the causes of these symptoms and their relationship to implants remain unclear. Discuss persistent symptoms with a healthcare provider so they can evaluate possible causes and review your options.
Get Answers About Breast Implant Changes
If a breast with an implant has become firmer, painful, or changed shape, Dr. Jeffrey Roth can evaluate what may be causing the change and discuss your options. Request a consultation using the online form or call his Las Vegas practice directly at (702) 450-0777 to learn whether monitoring or breast augmentation revision may be appropriate for you.
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