Capsular Contracture - Breast

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What is capsular contracture?

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Once a breast implant is in place, fibrous scar tissue forms around it, creating a tissue capsule. The body forms a protective capsule like this around any object it recognizes as foreign. The tissue capsule is usually soft or slightly firm, not noticeable, and helps to keep the implant in place. 

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Sometimes a tissue capsule forms that is unusually hard and dense. The capsule tightens around and squeezes the implant. This condition is called capsular contracture, and it’s a possible complication of breast implant reconstruction surgery. Capsular contracture can distort the encapsulated breast implant and make it shift upward on the chest. The condition can also cause chronic pain. 

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Who is at risk of developing capsular contracture?

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If you’ve had radiation therapy at any time in the past — and particularly if you had it after your initial breast reconstruction surgery — it can greatly increase your risk of developing capsular contracture. But overall, the reasons that some people develop capsular contracture while others do not are not well understood.

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Some other factors that may increase the risk of developing capsular contracture include: 

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  breast implant rupture 

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  a buildup of blood where tissue was removed during surgery (called hematoma) 

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  infection (when a microbial biofilm forms on an implant)

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  a genetic predisposition to forming scars

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Capsular contracture symptoms and signs

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Capsular contracture symptoms include increasing firmness or tightness in the breast. Signs of the condition can start to appear as early as a few months after your breast implant reconstruction surgery or even years afterward.

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You may want to consider corrective surgery for capsular contracture if it’s causing chronic pain, restricted range of motion, or changes in the position and shape of the breast.

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Capsular contracture treatments

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Some of the options for correcting capsular contracture include:

Capsulectomy

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During a capsulectomy, your surgeon removes the existing breast implant and the surrounding tissue capsule and inserts a new implant that is wrapped in a sheet of dermal matrix material (a skin substitute made mostly of collagen). The dermal matrix material provides an extra protective layer. Your body forms a new capsule of scar tissue around it.

Open capsulotomy

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During an open capsulotomy, your plastic surgeon attempts to cut open the tissue capsule around the breast implant by making small incisions and may also remove some of the capsule. The goal is for the capsule to pop open, giving the implant more room to move around. In some cases, your surgeon might also remove your existing implant and replace it with a new one.

Flap reconstruction surgery

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During a flap reconstruction procedure, your plastic surgeon removes your breast implant and reconstructs your breast with a flap of tissue transplanted from another area of your body, such as your belly or buttocks. An important advantage to this approach is that it eliminates the risk of capsular contracture happening again because tissue capsules don’t form around flaps. However, flap reconstruction is a more complex surgery with a longer recovery time than a capsulectomy or open capsulotomy.

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