Doubts and questions about capsular contracture or encapsulation of breast prosthesis are common among patients who come to my office with the intention of undergoing breast augmentation. Capsular contracture occurs when the tissue surrounding the breast implant begins to become firmer than expected, which causes the shape of the breast to change, the breast hardens and can become painful when resting..
Common questions about capsular contractures
Breast prosthesis encapsulation is the most frequent complication after breast augmentation and is around 4-8%.
It is not possible to predict which patient will develop capsular contracture, nor why one breast may stiffen and the other may not.
Why does capsular contracture occur?
The most accepted theory is bacterial contamination of the prosthesis from the mammary gland. Other times capsular contracture occurs after a hematoma or seroma following breast augmentation surgery.
What do we do to reduce the risk of capsular contracture?
In our surgeries we always take into account the following considerations:
- We use textured cohesive gel implants with low transudate rate.
- We place the implant in a submuscular position or behind the fascia of the pectoralis muscle.
- Massage. I sometimes recommend them to reduce breast swelling after surgery.
- I always use the “no-touch” technique: this is the set of measures designed to keep the implant in contact with the operating room air, the patient’s skin, the surgical instruments and the surgeon’s gloves for the shortest possible time in order to minimize the risk of contamination of the prosthesis..
How is it diagnosed?
The diagnosis of capsular contracture is clinical, although mammography, ultrasound or magnetic resonance imaging will show a thickening of the capsule around the prosthesis.
The patient begins to notice unspecific discomfort, that one or both breasts are not as soft as long ago, which is changing shape, etc..
There are four degrees of capsular contracture:
- Grade I: soft and normal breast. Normal status after augmentation mammoplasty surgery.
- Grade II: harder breast with palpation of the prosthesis.
- Grade III: harder breast, the prosthesis is more easily palpated and a change in the shape of the breast can be appreciated.
- Grade IV: hard, painful, distorted breast.
How is capsular contracture treated?
If you begin to notice any symptoms or signs of capsular contracture, it is advisable to make another appointment for a new control by us.
We treat grade II by monitoring the evolution in the office. Sometimes we associate the treatment with oral vitamin E with good results.
The treatment of a grade III and IV capsular contracture is surgical.
Once the capsular contracture has occurred and is grade III or IV, we advise the removal of the capsule, change of plane to submuscular plane if the prosthesis was in the subglandular or subfascial plane or use of polyurethane prosthesis due to the guarantee they offer (in writing) of absence of new capsular contracture during the first ten years.
To learn more about Breast Augmentation, you can read this SECPRE article.
