Capsular contracture is an uncommon but serious side effect of breast augmentation surgery. It’s a word used in plastic surgery to describe the growth of excessive scar tissue around a breast implant. Although the exact origin is unknown, significant bleeding following surgery and probable bacterial infection appear to be the most common causes.
Capsular contracture is still a bothersome and costly condition in cosmetic surgery. Contracture can be reduced by adopting procedures like the no-touch Keller Funnel while putting breast implants during breast augmentation.
4 stages of Capsular Contracture
- Grade I Capsular Contracture
For starters, all breast implants result in the formation of a capsule. Internally, the wonderful mechanism that is the human body detects the presence of a foreign body. The soft capsule that forms around the breast implant is fully biological and physiologic. This capsule serves as a permanent “home” for the breast implant, which is beneficial to both the patient and the plastic surgeon. This sort of capsule is referred to as Grade I. At this time, no therapy or monitoring is required. This is what both the patient and the plastic surgeon desire. Grade I breasts are typically soft and appear to be of average size and form.
- Grade II Capsular Contracture
The capsule is classified as a Grade II capsule when the capsule contracture thickens and the implant feels somewhat stiffer but does not affect its overall shape. The good news is that surgery is seldom necessary. In these cases, we only use medicinal and mechanical methods to cure the capsule. At this time, lymphatic massage, ultrasound treatment, and Zafirlukast can commonly reverse thickness and save your augmentation. The breast in grade II is a touch hard but otherwise seems typical.
- Grade III Capsular Contracture
The second stage of capsular contracture includes the implant capsule hardening even further, however, this time the hardening has altered the overall form of your implant and/or breast. The breast in grade III is firm and irregular in appearance. This sort of Capsular Contracture is referred to as Grade III, and it is quite unpleasant for women, but it is treatable!! Treatment entails a delicate balancing of medical and surgical treatment, as well as, as always, open and honest communication between our team and you. The capsule has caused a mechanical compression of the implant at this point. Surgical revision is required for these individuals. As always, the type of surgery employed is tailored to the needs of the patient, and we provide a variety of options:
Partial Capsulectomy – In this treatment, only a part of the capsule is removed. This is the least frequent method for contracture therapy, however, it can help certain individuals with a small region of scar contracture. This technique is usually performed on individuals who have not had their implant descend properly unilaterally. Only the problematic capsule region is removed after surgery. Patients are initiated on lymphatic massage and medicinal treatment after surgery. This treatment is quite effective in well-selected patients, but not all patients are candidates for this technique. Surgical drains are not used during this surgery.
Total Capsulectomy – This procedure removes your current implant’s capsule as well as all associated scar tissue. After removing the implant and capsule, the whole region is treated with a triple antibiotic solution before a new implant is inserted. Depending on the form and size of the breasts, this sort of operation may also necessitate a breast lift.
Neopectoral Pocket – This procedure takes advantage of the aberrant capsule! The capsule is precisely dissected away from the surrounding breast tissue and muscle in this technique. Following that, the capsule is deflated down to the chest wall and oversewn to give the new implant additional projection and volume. This is a wonderful contracture strategy that produces some of our best outcomes. Unfortunately, this surgery necessitates the use of a tiny 8mm surgical drain on either side. Between days 3-5 after surgery, the drain is routinely removed. We undertake a highly specific technique in this case.
Strattice’s Implant Plant Exchange – Long-term clinical evidence shows that implants put above the muscle have a higher rate of capsular contracture than implants placed below the muscle. Total capsulectomy, removal of your present implant, and insertion of a new implant beneath the muscle with a Strattice sling is the treatment of choice if you have an above-the-muscle implant with contracture. This is the most prevalent type of revision because it gives your breast a delicate, natural appearance. Strattice is a form of a biological mesh that, once within your body, revascularizes. It effectively becomes a permanent internal support bra for your implant in its new place, since it becomes a part of the breast structure.
While most customers want to maintain their augmentation, many do not want to keep their implants. Implant Removal Only – This is a highly practical technique to addressing contracture, and while most clients want to keep their augmentation, many do not want to keep their implant. The whole implant can be removed without a capsulectomy with only a local anesthetic. The capsule is left behind in this method, although it will usually soften up with time. Secondary capsulectomy can be undertaken subsequently to minimize the internal scar load if it continues to harden.
- Grade IV Capsular Contracture
Grade IV capsular contracture is characterized by a constant dull throbbing ache and, more typically, a sensation that the breast is colder to the touch. Your therapy options are the same as for Grade III. Post-operatively, patients are kept on the most aggressive medical treatment possible (massage, Zafirlukast). In this population, complete capsulectomy with Strattice sling is prevalent. The breast is hard, unpleasant to the touch, and seems aberrant in grade IV.
In general, the following is a method for accurately distinguishing the four grades:
Grade I – Breasts are soft and natural-looking.
Breasts are slightly firm yet seem typical in Grade II.
Grade III – The breasts are firm and deformed.
Grade IV – The breasts are firm and deformed.
WHAT CAUSES CAPSULAR CONTRACTURE?
Several variables may play a role in the development of capsular contracture. Hematoma, bleeding, or silicone gel leaking from a burst implant are examples. Patients may get hematomas or implant ruptures at any moment. Patients may have been traumatized by a particularly difficult mammogram or by impact from a fall or automobile accident.
Bleeding surrounding the implant after surgery or trauma might function as a stimulating agent, causing the breast implant capsule to expand. Bacterial contamination has also been shown to have a role in the development of aberrant capsule formation, whether it is acute or chronic. Around a breast implant, bacteria build a biofilm or slime layer, which can irritate the capsule. This causes hardness, pain, and sometimes death, as well as alterations in breast shape.
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3 Main causes of Capsular Contracture
• Although it is not usually the case, a hematoma or seroma during or after a breast implant surgical process might result in a problem.
• A Contaminate or Germs: These might enter the capsule that is linked to the breast implant shell during the breast implant surgical operation.
• Infection: If an infection develops around the implant after the implant surgical process, capsular contracture can develop, however, this is uncommon.
Ways to Avoid Capsular Contracture in Breast Augmentation
Although this is not a common issue, it can happen, and there are a few strategies to prevent it, including:
• The kind of incision
The type of incision you choose before surgery has an impact on your chances of developing capsular contracture. The areolar incision is fantastic, however, the germs in the areolar ducts are resistant to surgical scrub or IV antibiotics. In breast augmentation surgery, a breast fold incision should reduce the risk of capsular contracture as much as feasible.
• Treatment with antibiotics during surgery
Excessive bleeding during and after surgery will minimize the chance of capsular contracture, as will a lack of blood in the breast implant pocket. Therefore, you should avoid intensive activity shortly after your surgery: raising your heart rate and blood pressure might result in severe bleeding around your breast implant.
- Excessive bleeding should be avoided during and after surgery.
Excessive bleeding during and after surgery will minimize the chance of capsular contracture, as will a lack of blood in the breast implant pocket. Therefore, you should avoid intensive activity shortly after your surgery: raising your heart rate and blood pressure might result in severe bleeding around your breast implant.
• Avoid becoming infected
Take antibiotics as instructed after your treatment to avoid infection and report any complications you have with your breast augmentation procedure to your plastic surgeon. Any infection has the potential to induce tissue hardening around your breast implants and should be avoided at all costs.
- Massage after breast implant surgery
Breast implant massage is an important part of post-surgery care and should be addressed following your breast augmentation. Breast implant massage time, dosage, direction, and frequency vary depending on your plastic surgeon and personal taste.
• The usage of anti-asthmatic medicine is a possibility.
Anti-asthma medicine has been demonstrated to minimize capsular contracture when administered within a specified time frame following your treatment. These anti-asthmatic drugs are considered to absorb and break down some of the chemical components that contribute to the hardening of scar tissue surrounding your breast implants. Some drugs may have negative effects; thus, it is advisable to consult with your plastic surgeon before using Singular, Accolate, or other medications.
• Application of ACDM/acellular dermal matrix
The use of ACDM/acellular dermal matrix in aesthetic breast augmentation surgery is a relatively new technique. It’s been utilized in breast reconstruction after mastectomy to help wounds heal and offer breast tissue thickness, and it’s becoming increasingly popular in tough breast augmentation cases with capsular contracture.
How to prevent Capsular Contracture
Several factors can lower the likelihood of capsular contracture. These are some examples:
1. Implants with textured surfaces
2. Antibiotics are second.
3. Implant insertion sub muscularly
4. inframammary incisions
5. Reducing the amount of time the implant is handled during surgery.
Breast Augmentation – Capsular Contracture Treatment Options
Breast augmentation with silicone or saline implants is generally safe, however, there are certain dangers and adverse effects to be aware of. Here are your treatment choices if you have it on one or both breasts after breast augmentation:
1. Capsulectomy
Because it eliminates the scar tissue from surrounding the implant, this is the most successful therapy. The chance of regrowth is lowered by eliminating it.
2. Capsulotomy
Only a little amount of scar tissue capsule is eliminated. The surgeon enters and dismantles the capsule that is obstructing the implants. If you don’t have a total contracture, this is a good option.
3. Compression and massage
Massage also keeps it from getting tight and rigid. To inhibit the progression of the capsular contracture and keep the region supple and flexible, compression exercises can be done.
4. Medications
Antibiotics, anti-inflammatories, and muscle relaxants can all be used to assist prevent scar tissue from growing. Certain medicines can block the body’s normal immunological response, preventing infection that might irritate the region. Vitamin E is a typical natural component that is also said to soften the skin.
5. Ultrasound
This should be used with caution as it has the potential to harm the implant if used for an extended period. It works by generating energy that softens scar tissue and helps to avoid painful contractions.
6. Capsulotomy with a closed opening
This is a non-invasive procedure that includes applying intense pressure to the implant and compressing it to release the capsular contracture. The breast tissues may be severely damaged because of this operation. This is something that implant manufacturers warn against.
THE BOTTOM LINE
There are various aspects of capsular contracture that you should be aware of before undergoing breast augmentation surgery. It is the most common reason for re-operation following both operations for a variety of reasons. Baker The severity of the Capsular Contracture is measured in grades. Grades 1 and 2 indicate significant capsular contracture, whereas grades 3 and 4 indicate an unnatural look, discomfort, firmness, and hardness of the afflicted breast.
Grades 1 and 2 indicate significant capsular contracture, whereas grades 3 and 4 indicate that the afflicted breast is unusual in appearance, painful, firm, and rigid.
DISCLAIMER: This is educational information and should not be used in place of professional medical advice. We strongly advise everyone to visit their primary care physician before acting on any Internet-provided advice.
