Capsular Contracture

Capsular contraction is a surgical procedure used to correct capsular contractures, which are the most common side effect experienced after undergoing a breast augmentation procedure.  A capsular contracture occurs when the pocket created for a breast implant heals and forms a capsule comprised of fibrous tissue.  In the ideal situation, the pocket will remain open and allow the breast implant to look and feel natural.  In the case of a capsular contraction, however, the scar tissue is shrunk by the body and the tissue tightens around the implant.  This can cause the breast to look distorted and too feel too hard.  In addition, a capsular contracture can be quite uncomfortable or even painful for the patient. 

Patients who smoke, those who choose to have a sub glandular implant and those who experience complications such as infection and seroma following the implant surgery are at a higher risk of developing capsular contracture. 

Understanding Capsular Contraction

Once it develops, there are four different grades of capsular contracture that a patient may experience.  These include:

• Grade I - the breasts still appear natural and soft
• Grade II - the breasts are starting to feel firm, but still appear natural
• Grade III - the breasts look abnormal and feel very firm
• Grade IV - the breasts look abnormal, feel hard and are painful

The extent of the capsular contracture will determine the exact procedure used during the capsular contraction surgery.  Nonetheless, the surgeon may choose to follow one of two different primary treatment plans.  The first is the closed capsulotomy, which involves manually squeezing the contracture from the outside in order to tear the scar envelope.  This technique provides instant relief, though it is not possible with all cases of capsular contracture because the scar envelope may be more resistant to tearing in some patients.  In addition, there is a risk that the implant will rupture when using this technique, which will require going through an additional surgery in order to remove and replace the implant.

The other technique, the open capsulectomy, is considered to be less risky than the closed technique.  With the closed capsulectomy, an incision is made in order to allow the surgeon to cut into the scar tissue and release the tension that has built up around the implant. The implant may also be reinserted before the incision is closed.  In most cases, the patient will need to stay overnight in the hospital or surgical center following the procedure.

Risks Associated with Capsular Contraction

As with any surgery, there are potential risks and complications associated with capsular contraction surgery.  Some of these include:

• Bleeding
• Blood clot formation
• Bruising
• Infection
• Negative reaction to anesthesia
• Numbness following surgery
• Scarring

In addition to the risks associated with any surgery, those undergoing capsular contraction surgery may also experience the following complications:

• Asymmetry of the breasts, particularly if only one breast requires being operated upon
• Feeling unsatisfied with the results
• Loss of sensitivity in the breasts or in the nipples
• Loss of the ability to breastfeed
• Re-hardening of the scar tissue following the procedure
• Rupturing of the implant

If the results are unsatisfactory, if the implant ruptures or if the scar tissue re-hardens, additional surgeries may be necessary.