Capsular contracture is the formation of firm or thick scar tissue around a breast implant causing it to become distorted and is one of the possible long-term complications that could arise from a breast augmentation procedure. It can occur within a few weeks of surgery or show up several years later. The development of this condition following insertion of breast implants is not a phenomenon that is not fully understood.
Lowering the Risk
It is a well-accepted fact that placing breast implants under the pectoralis (chest) muscle significantly reduces the incidence of capsular contracture, compared to placing breast implants on top of the chest muscle. Moreover, it is known that saline breast implants typically tend to have a lower incidence of capsular contracture in comparison to silicone implants, which had a very high incidence of hard capsule formation. Most of the silicone implants placed prior to 1991 had thin implant shells as well as a very liquid-like gel which could leak through the surface of the implant causing an inflammatory reaction which was felt to contribute to this scar formation. Modern day silicone implants have considerable thicker silicone walls and the internal gel is much more viscous or gelatin-like making bleeding of silicone through the shell much less of a problem.
Many plastic surgeons recommend that their patients frequently massage their breasts to reduce the incidence of capsular contracture. The thought process is, if you can keep the implant pocket bigger than the size of the implant, the scar capsule cannot compress the implant and make it feel hard. Patients should know that there is not any good evidence to support the idea that the use of breast massage following a breast augmentation procedure lowers the risk of capsular contracture. Furthermore, taking high doses of vitamin E, or any other medication, again recommended by some surgeons, has not appeared to successfully treat or prevent the condition either.
Excess Bleeding Increases RIsk
Excess blood in the implant pocket after surgery can contribute to the formation of scar tissue and potentially a capsular contracture. So avoiding taking any medication for two weeks before surgery that can contribute to excessive bleeding can help to reduce the incidence of capsular contracture. We provide all surgical patients with an extensive list of these medications and we encourage everyone to be diligent in adhering to this list.
One of the newest theories as to why capsular contractures occur is the formation of a microscopic film around the implant, known as biofilm. This film is produced by bacteria, which can grow on the surface of the implant and live inside of this film. There is evidence to suggest that this film can contribute to capsular contracture formation. If antibiotics have been prescribed to you at the time of your surgery, be sure to follow the instructions on taking this and all medications that have been prescribed to you.