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Capsular Contracture after Breast Augmentation: Causes, Symptoms, and Treatment

Articles 19 June 2016

Breast Augmentation involves far fewer early complications than an ordinary surgical operation. Bleeding, post-bleeding and wound infection are very rare. This is due to the precise, individualized but standardized surgery methods, and to the high-level technical knowledge of plastic surgeon colleagues.

Even the most cautious plastic surgeons are not able to exert maximum influence in all circumstances. Capsular Contraction around the breast implant is an unexpected but occurring phenomenon. The most frequent complication after Breast Augmentation, but fortunately very rare these days.

The body accommodates the tissue-friendly implant by forming a connective tissue layer around it. This is a so-called capsule consisting of fibroblasts (connective tissue producing fibers), collagen, and small blood vessels. Capsule formation is a normal and healthy process, but if it is too thick or shrinking it may cause problems.

This risk is higher among those who once had it, but a new textured or polyurethane-coated implants make the secondary augmentation safer.

Grades of Capsular Contracture

The severity of Capsular Contracture is graded on the Baker scale.

Degree I refers to normal capsule formation. In this process, a connective tissue case is formed around the breast implant, which provides a soft touch and a natural effect.

With degree II, there is a slightly tight and hard capsule that is palpable but the sight is still natural.

Degree III is an actual Capsular Contracture. The capsule is so hardened that it visibly distorts the breasts, often with exaggerated roundness and an unnatural curvature of the upper pole.

Degree IV refers to hard, cold, distorted, painful breasts. The thickened capsule thins the tissues around it.

Causes of Capsular Contracture

Even with today’s quality breast implants and surgical techniques, it is not predictable that how the body will react to the material. For some older types and low-quality implants, there is a higher risk of Capsular Contracture, just like when the method of implantation is not the most appropriate.

For example, if the implants were placed over the pectoral muscle, directly under the glands, the covering of the implants is not always enough which increases the cell formation process and thus increases the risk of contracture. Inadequate surgical conditions, such as lack of sterility, also increase the risk.

Based on our own experience, we have observed in many cases that the histology samples from the old capsule contained microscopic traces of earlier bacterial infection in patients who had had primary Breast Augmentation in other clinics.

After several decades of research, it can be concluded that the “biofilm” theory is the most accepted and most probable cause of the occasional thickening and shrinkage of the capsule around the breast implant.

Breast implants, like any other medical device implanted in the body (eg. dental implants, internal fixation for fractures, bone plates etc.), are a sterile, neutral, harmless but foreign materials. Therefore, the body surrounds them with a thin layer of connective tissue in approx. 3-6 weeks. During this time it is very important for the patient to remain completely healthy and to ensure optimal conditions for wound healing.

Any disease developed during this period enhances the chance of later Capsular Contracture due to the formation of biofilm, which is a layer of bacteria, bacterial degradation products, and proteins. The process of scarring and healing, including the entire formation of the capsule, lasts for 1-1,5 years. Of this, the most intensive period in the formation of the optimal capsule is between the third and the seventh months.

The risk of Capsular Contracture is the highest during this period, but it may occur at any time even after many years, eg. because of excessive exertion, untreated inflammation in the body.

Prevention of Capsular Contracture

Dr. Pataki believes that the following precautions can minimize the risk of Capsular Contracture.

  • Placement of the breast implant (at least partially) under the muscle.
  • Quality (lifetime-warranty) cohesive silicone breast implants.
  • Textured or polyurethane-coated implants.
  • Correct implant size.
  • Correct size of the implant pocket.
  • Rinsing the pocket with a special antibiotic solution.
  • Perfect hemostasis.
  • Using the best tissue-friendly technique (eg. ultrasonic scalpel).
  • The use of less heat-generating devices (avoiding monopolar cauter).
  • The strictest sterilization rules n the operating room (eg. special mouth mask).
  • Smoking cessation before surgery.
  • Taking muscle relaxants and anti-inflammatory drugs for at least 1-2 weeks after the operation, cooling.
  • Mild, not exaggerated postoperative massage (started 2-3 weeks after surgery).

Treatment of Capsular Contracture

In Baker scale III or IV Capsular Contracture, capsulectomy is recommended, which means removal of the breast implant with the capsule itself. It is possible to insert another implant even at the same time, but it also depends on the severity of the inflammation and the wishes of the patient. In grades III and IV, we also recommend microstructural fat grafting for volume replacement in the thinned tissues of the breast, tissue regeneration, and scar prevention. Grade II does not always require surgery, rather than yearly (semi-annual) medical check-ups.


Breast Surgery Info

Complex information page with a description of the breast surgery procedures, a unique glossary - an explanation of the most important terms - and essential knowledge on the pre-and post-operative period.

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