Understanding Capsular Contracture: Causes Symptoms, and Treatments

For the most part, breast implant surgery is a reasonably safe procedure that has stood the test of time. However, even patients of the most skilled surgeons may encounter complications from the surgery due to a significant build-up of scar tissue as the body reacts to the new implants. This condition is called capsular contracture, and, according to The American Society of Plastic Surgeons, around one in six patients experience some form of it. Dr. Barrett, a top capsular contracture removal surgeon in Los Angeles, refers to the complication as “a breast surgeon’s most frequent enemy.” But, with the proper techniques and early diagnosis, it’s easily treatable.

Everyone’s body reacts to injury differently, and some bodies naturally create thick, dense scar tissue as a part of the healing process. For some, thick scarring is genetic. This is why some people are more prone to keloids or prominent stretch marks — capsular contracture is simply an excess of internal scarring that forms a capsule around the breast implant. Depending on the severity, this kind of internal scarring can lead to discomfort and disfigurement. Patients usually fall into two categories: early capsular contracture, which surgeons believe results from factors related to surgery, such as bacteria introduced when the implants are placed or disruption during the body’s initial healing processes, or late-stage capsular contracture, which is usually caused by implant ruptures or negative response by the immune system.

Symptoms of capsular contracture include breasts that feel hard to the touch; breasts that appear distorted, rounded, or off-centered; feelings of discomfort around the implant area; or implant rupture, which may or may not be visible externally. Because of the nature of these symptoms, capsular contracture is often diagnosed through a physical examination by a specialist or through imaging tests to see how extreme the scarring is. The condition is measured using a four-tiered grading system called the Baker Scale of Capsular Contracture. The scale ranges from Grade 1, representing asymptomatic scarring, to Grade 4, representing painful and disfigured breasts. Based on the level of scarring, the surgeon and patient will create an individualized treatment plan to correct disfigurement and relieve any pain or other complications. About seventy-five percent of all incidences of capsular contracture occur within two years.

There are various options to rectify capsular contracture in implant patients. For less extreme instances of excess scarring, massage therapy is a great treatment to try and smooth out the scar tissue. When that doesn’t work, or the tissue is already too far gone, surgical correction is the best option. There are three main methods of corrective procedures:

1. Closed capsulotomy: The surgeon applies firm manual compression to the outside of the breast to break off the scar tissue inside. This method does not require incisions or a new implant, making it the least invasive of all the treatment options.
2. Open capsulectomy: The surgeon removes the scar tissue from around the implant. This technique requires an incision within the breast area to excise the scarring. If necessary, the surgeon will also switch out the old breast implant for a new one.
3. In-continuity or en-bloc removal: The surgeon removes the implant and the scar tissue at the same time in a single unit. This method is commonly used when tissue buildup is caused by bacteria (such as Staphylococcus epidermis or staph epi) or a silicone implant rupture.

Although capsular contracture is sometimes unavoidable, many options exist to correct the complication and restore the patient’s breasts to look and feel the best they can. Early detection is vital, the faster a build-up of scar tissue is detected, the easier it is to treat, but with the right surgeon, capsular contracture can be treated at any stage.

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