capsular contracture

As survey results at the end of 2014 revealed, breast augmentation was still the most popular surgical cosmetic treatment in the UK. The popularity of breast implant surgery has remained unchanged for many years and with the numbers of women undergoing this procedure, it is important to recognise some of the potential risks of the procedure which can require further surgery. The most important of these risks is capsular contracture.

What is a capsular contracture?
When an implant is inserted into the breast, the body reacts by forming a lining around it – which is known as the tissue capsule. Sometimes, and for reasons unknown, this capsule thickens and contracts forming a capsular contracture. A capsular contracture can simply result in firmness around the implant or it can progress to causing a change in shape and will ultimately cause discomfort if left untreated.

What is the risk of developing capsular contracture?
The overall risk of developing capsular contracture is variable and can be anywhere up to 10 to 15% of individuals with breast implants.

How is capsular contracture graded?
Capsular contracture is graded on the Baker scale, which has four intervals depending on the level of contracture:

Grade 1 means that the breast looks and feels normal, and is still soft – medically, this means a capsule has developed but it is not contracted.
Grade 2 refers to mild to moderate contracture of the implant, whereupon the breasts will feel firm but the contracture will not be visible to the naked eye.
Grade 3 capsular contracture will not only affect how the breast feels, but may have begun to distort the shape of the breast, making it rounder. Alternatively, the implant may be being squeezed out of its normal shape in a different way – usually driving the implant upwards.
Grade 4 refers to grade 3, but the implant also becomes painful, caused by the progressive tightening of the capsule.

How is capsular contracture treated?
The surgical correction for capsular contraction is known as capsulectomy. This is a procedure where all or part of the thickened capsule around the breast implant is removed. At the same time a replacement of the breast implant is required. If the breast implant is on top of the muscle it is usually beneficial for the new implant to be replaced under the muscle.  The surgery is more involved than a primary breast implant procedure. It will need a general anaesthetic and a one-night stay in hospital. A surgical drain is required which is a tube which comes out through the skin and allows any fluid that accumulates to be collected in a bottle rather than within the breast. This tube is removed the following day after the surgery. The recovery is approximately 2 weeks after which you may return to work but heavy exercise needs to be avoided for 6 weeks.

What type of breast implant is best for replacement after a capsular contracture?
It is best to use a textured implant to minimise the chances of developing a capsular contracture. There are also alternative implants which have a polyurethane coating which reduce the risks of capsular contracture. The use of these polyurethane coated implants is becoming more widespread in view of the long-term advantages of reducing capsular contracture rates. They are certainly an important consideration if the capsular contracture is severe or if a capsular contracture has occurred on more than one occasion.

Your Consultation
Whether or not you had your breast augmentation with Mr. Chana, he welcomes all patients who are suffering from capsular contracture to attend a consultation with him. Mr. Chana is an experienced surgeon with over 20 years as a plastic surgeon, and will be able to assess the degree of your contracture and offer a solution. He will explain in detail to you what your surgery will entail, and the sort of results you can expect. He will also carefully explain anything you should do pre- or postoperatively to aid a healthy recovery.

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