Breast augmentation is a popular cosmetic procedure that involves the placement of breast implants to enhance the size and shape of the breasts. While breast implants generally provide natural-looking and soft results, in some cases, individuals may experience a complication called capsular contracture, which can cause the implants to harden. In this article, we will explore the causes of breast implants hardening and discuss the condition known as capsular contracture in more detail.
What is Capsular Contracture?
Capsular contracture is a condition that occurs when scar tissue forms around the breast implant, creating a tight or constricting capsule. This scar tissue, also known as the capsule, is a normal response of the body to the presence of a foreign object, such as a breast implant. In most cases, the capsule remains thin and flexible, allowing the implant to move naturally and maintain a soft and natural feel.
However, in instances of capsular contracture, the scar tissue becomes thickened and contracts, resulting in the hardening of the breast implant. This can cause discomfort, distortion of the breast shape, and changes in breast appearance.
Causes of Capsular Contracture
The exact cause of capsular contracture is not fully understood, and it can vary from person to person. However, several factors have been identified as potential contributors to the development of this condition. These include:
- Biofilm Formation: Biofilm refers to a slimy coating that can develop on the surface of breast implants. It is believed that certain types of bacteria in the body can form a biofilm, leading to an inflammatory response and the development of a thickened and contracted capsule.
- Bacterial Contamination: Bacterial contamination during the surgical placement of breast implants can increase the risk of capsular contracture. While efforts are made to maintain sterile conditions during surgery, the presence of bacteria can trigger an immune response and the formation of excessive scar tissue.
- Hematoma or Seroma: A hematoma is a collection of blood, while a seroma is a collection of fluid, both of which can occur after breast augmentation surgery. The presence of blood or fluid around the breast implant can increase the risk of capsular contracture by promoting inflammation and the development of a thickened capsule.
- Implant Texture and Type: The type and texture of the breast implant may influence the risk of capsular contracture. Textured implants, which have a rough surface, were initially introduced to reduce the risk of capsular contracture. However, recent studies have suggested that certain types of textured implants may actually increase the risk of this complication.
- Genetic Predisposition: Some individuals may have a genetic predisposition to developing excessive scar tissue or an abnormal immune response, making them more susceptible to capsular contracture.
- Smoking: Smoking has been associated with an increased risk of capsular contracture. Smoking constricts blood vessels and impairs the body’s ability to heal, potentially leading to complications such as excessive scar tissue formation.
Grades of Capsular Contracture
Capsular contracture is typically graded on a scale known as the Baker Scale. The scale ranges from Grade I to Grade IV, with each grade representing a different degree of severity:
- Grade I: The breast feels soft and appears natural.
- Grade II: The breast feels slightly firm but looks normal.
- Grade III: The breast feels firm, and there may be visible distortion in shape.
- Grade IV: The breast feels hard, looks distorted, and may be painful.
Treatment Options for Capsular Contracture
If capsular contracture occurs and causes discomfort or affects the aesthetic outcome, several treatment options can be considered:
- Non-Surgical Intervention: In some cases, non-surgical interventions may help alleviate the symptoms of capsular contracture. This can include massaging the breasts, wearing compression garments, or taking medications to reduce inflammation.
- Surgical Revision: Surgical intervention is often necessary for more advanced cases of capsular contracture. The procedure involves removing the scar tissue (capsulotomy) or completely removing the capsule (capsulectomy). In some instances, the implant may also need to be replaced.
- Implant Exchange: In cases where capsular contracture is severe or recurrent, the implant may need to be exchanged for a new one. The surgeon may also consider using a different type of implant, such as switching from textured to smooth implants.
- En Bloc Capsulectomy: In certain situations, an en bloc capsulectomy may be recommended. This involves removing the implant and the entire capsule as one intact unit, reducing the risk of implant contamination or rupture.
Prevention of Capsular Contracture
While it may not be possible to completely prevent capsular contracture, there are steps that can be taken to minimize the risk:
- Choose an Experienced Surgeon: Selecting a board-certified plastic surgeon with extensive experience in breast augmentation can help reduce the risk of complications, including capsular contracture.
- Follow Proper Post-Operative Care: Following your surgeon’s post-operative instructions, including wearing compression garments, taking prescribed medications, and attending follow-up appointments, is crucial for optimal healing and reducing the risk of complications.
- Avoid Smoking and Secondhand Smoke: Smoking is a known risk factor for capsular contracture. It is essential to refrain from smoking and avoid exposure to secondhand smoke both before and after the surgery.
- Consider Implant Placement: The placement of the breast implant may affect the risk of capsular contracture. Discuss the pros and cons of different placement options, such as submuscular (under the chest muscle) or subglandular (above the muscle), with your surgeon to determine the best approach for your specific situation.
- Regular Monitoring: Regular follow-up visits with your plastic surgeon allow for the early detection of any changes or complications, such as capsular contracture. Routine breast examinations, mammograms, or imaging studies may be recommended to monitor the condition of the breast implants.
Conclusion
Capsular contracture is a potential complication that can cause breast implants to harden. While the exact cause is not fully understood, factors such as biofilm formation, bacterial contamination, and genetic predisposition may contribute to its development. Understanding the potential causes, risk factors, and treatment options for capsular contracture is crucial for individuals considering or who have undergone breast augmentation. Consulting with a skilled plastic surgeon and following proper post-operative care can help minimize the risk of capsular contracture and promote a successful breast augmentation outcome. Regular monitoring and prompt intervention can address the condition if it occurs, allowing individuals to enjoy the benefits of their breast implants with optimal comfort and aesthetic results.
