Capsular contracture means tightening of the capsule. Any non-absorbable foreign body which stays inside us will eventually form a capsule around it. In effect, since the body can’t expel the foreign body, our bodies ignore it by hiding it inside a “cocoon”.
The same principal applies to breast implants as well, no matter what style of implant or manufacturer is used.
In my Orange County practice, on a yearly basis, I see a handful of patients who develop capsular contracture after breast augmentation. When I say a handful, I am describing the patient which has visible and non-visible effects from the contracture. The percentage, therefore, is low. However, the incident of contracture increases with the age of the implant.
The most common system used for describing capsular contracture is the Baker-Gordon Classification:
Grade I-the implant and the breast feel soft, and look natural
Grade II-the implant feels slightly firm (not-objectionable), and the breast looks natural
Grade III-the implant feels hard and the breast looks abnormal
Grade IV-the implant feels hard, is painful to touch, and the breast looks abnormal
Once grade III and IV contracture has occurred, the only solution is surgical correction.
There are two surgical options to correct the deformity: capsulotomy and capsulectomy. Capsulotomy means cutting the capsule. Radial cuts are made in the capsule, resulting in expansion of the capsule. Capsulectomy involves removing the capsule. As can be expected, capsulectomy is a more involved process, and as careful as a surgeon is, a small amount of breast tissue is attached and thus removed in the process. This can result in a higher chance of skin thinning, compared to capsulotomy. I, therefore, reserve capsulectomy for a very thick capsule which does not “yield” easily, or in someone who develops recurrent capsular contracture after capsulotomy.
In my experience, most early capsular contracture is usually due to two factors: post-operative bleed inside the breast 1-7 days after surgery, and patient non-compliance.
It is critical the patient refrain from any rapid upper body activity or heavy lifting the first month, and especially the first week. I have had patients who picked up their child the next day after surgery, or vacuumed the house within the first week (talk about being tough!) and developed a hematoma (collection of blood) inside the breast. If the hematoma is small, it will absorb with time. If the hematoma is large, then surgery is required to remove it. Regardless, patients who develop post-op bleeding are at much higher risk of developing capsular contracture. This may be due to the inflammatory, “attacking” response of the body to clear the blood clot.
Patients who are non-compliant with their implant massage also are at higher chance of developing contracture. My theory is that the body is not used to the new pocket created for the implant, and the massage is critical to keep the pocket from closing. It typically takes 2-3 months for the body to form the capsule. That is why it is critical to massage the implants often during the first three months.
Capsular contracture with aging of the implant is out of our control. Neither the patient nor I can predict when the contracture will occur and how to prevent it. Having said that, majority of patients enjoy their “new” breasts for many years to come!
Michael A. Jazayeri, M.D. is a board certified plastic surgeon with over 10 years of experience. His office is located in central Orange County. To schedule a complimentary consultation, please call (714) 834-0101.
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