Breast augmentation is the most common cosmetic surgical procedure performed in the United States. In 2014 there were over 286,000 breast augmentations performed. With the large numbers of breast augmentations having been performed and the millions of women who have breast implants, this has proven to be a very safe operation with great patient satisfaction and minimal risk of complications.
There are, however, a few potential risks of breast augmentation that women need to be aware of. One of the possibilities is the development of capsular contracture – often referred to as hardening of the breast implants. Capsular contracture develops in approximately 8-15% of women who undergo breast augmentation. Capsular contracture is the development of scar tissue around the implant that one can tell is there. (The implant itself does not actually harden.) Any time an object is implanted in the body, the body forms a thin layer of scar tissue around that object, whether it is a pacemaker, breast implant or any other device. For breast augmentation, this layer of scar tissue is referred to as the capsule.
The capsule around a breast implant is normally very thin and very flexible and you cannot tell that it is there. In some cases, the capsule thickens, tightens and contracts around the implant (think shrink wrapped plastic). When this happens the implant may feel firm, sometimes it feels hard and sometimes it can be uncomfortable. In addition to making the implant feel firm the capsule can sometimes alter the shape of the implant or pull it slightly out of position. Any of these conditions is referred to as capsular contracture.
Capsular Contracture Fast Facts
- Capsular contracture is not a medical condition and does not lead to any illness or disease.
- It can be bothersome to a woman who has it and it will not resolve on its own.
- The exact cause of capsular contracture is unknown. There are several theories and different mechanisms may be responsible in different situations.
- Most cases of capsular contracture occur in the first two years following surgery.
- Later development of capsular contracture may be caused by significant trauma to the breast or possibly a leaking silicone implant.
Treating Capsular Contracture
In the past capsular contracture has been treated by squeezing the breasts hard enough until the capsule ruptures. This practice has been frowned upon since the mid 1990’s and there are specific recommendations against it. The most common and most successful way to treat capsular contracture is to surgically remove the scar tissue through breast revision surgery. The surgical removal of capsular contracture is most commonly an outpatient procedure with recovery similar to that of the original breast augmentation. If the implants were initially placed above the chest wall muscle, when treating capsular contracture, the implants are commonly repositioned behind the chest wall muscle. There is evidence that would indicate that repositioning the implants under the chest wall muscle can decrease the occurrence of capsular contracture.
The timing of the treatment of capsular contracture is not critical. The surgery may be performed soon after the contracture is diagnosed or anytime thereafter. Many women who have only a small amount of contracture and who are not bothered by it may choose to delay any treatment indefinitely or even do nothing about it.
Fortunately, most cases of capsular contracture can be treated with a single procedure and the contracture rarely recurs. There are a few women who have developed repeated capsular contracture. These situations are more difficult to treat and may involve the use of ADM (acellular dermal matrix) or biological mesh (SERI) to minimize the risk of additional contracture.
Dr. Nein has treated many cases of capsular contracture with breast revision surgery. These women usually had their breast augmentations done elsewhere and were referred to Dr. Nein by their friends. Dr. Nein has been very successful in surgically correcting the capsular contracture and returning the breast to a natural appearance and soft feel. In the treatment of the first occurrence of capsular contracture, Dr. Nein has avoided the use of ADMs and SERI in an effort to reduce patient costs. Fortunately, subsequent recurrences of capsular contracture have been exceedingly rare.