What is Capsular Contracture?

September 14, 2017

Published 09/14/2017

Forming scar tissue is a natural response by the body to a “foreign object”, in this case, the breast implant. A capsule forms in all cases, but it is only with tightening and constriction of this scar that a capsular contracture occurs.

Breast augmentation surgery is one of the most common cosmetic surgeries performed by Dr. Ravi Somayazula in Houston. There are many reasons for this, the primary being that he specialize in breast and body contouring plastic surgery. Dr. Ravi is also board certified by the American Board of Plastic Surgery. With his office located centrally within Houston, specifically in the Memorial neighborhood, many women from all parts of Houston and Texas are evaluated by him during a breast augmentation consultation. He believes strongly in personally see all the new patients in his practice so that they can get to know the surgeon they may eventually choose and in order for him to best understand their goals to make a comprehensive plan. Dr. Ravi use this time to explain the benefits and possible complications of surgery; as in all surgery, there are inherent risks. One known complication of breast augmentation surgery is capsular contracture.

Forming scar tissue is a natural response by the body to a “foreign object”, in this case, the breast implant. A capsule forms in all cases, but it is only with tightening and constriction of this scar that a capsular contracture occurs. This tightening of the scar leads to misshapen or hard breasts that can present with pain or stiffness along with altered appearance or shape. There are many factors that vary the risk of capsular contracture, including implant type, texture, position and site of insertion. The areolar incision carries a higher risk than the inframammary incision. Placing the implant above the muscle also carries a higher risk than placement below the muscle.

While the overall incidence is low, scientific evidence has supported certain causative factors that can increase the risk of capsular contracture. We now know that when the breast implant comes into contact with the patient’s skin at the time of surgery a certain biofilm forms on the surface of the implant. This biofilm is due to the normal skin flora, or bacteria, that is present. Unfortunately, this biofilm can lead to an increase risk of the scar tissue becoming more stiff and hard.

The diagnosis of a capsular contracture is clinical and should only be made by a board certified plastic surgeon. There are 4 Grades to classify capsular contractures.

• Grade I – the breast is soft and there is essentially no capsular contracture.
• Grade 2 – the breast is slightly firm but the breast shape is normal.
• Grade 3 – the breast is hard and firm and the breast appears distorted by the hardened capsule. Usually, the implant is displaced superiorly and looks unnaturally round.
• Grade 4 – the breast is hard, firm and painful with the breast appearing distorted.

Management of capsular contracture include both medical and surgical treatments. In early stages of capsular contracture, such as grade 2, medical management with pharmacological agents such as Singular (a leukotriene receptor antagonist) and Prednisone (a steroid) may help soften the capsule and prevent its progression. If after 3 months of medical therapy there is no improvement, surgery is warranted. Surgery is also first line treatment for Grades 3 and 4 capsular contractures.

There are a few known ways to decrease the risk of capsular contracture formation. The first being a meticulously sterile technique during surgery, called the “No Touch” technique with use of the Keller Funnel® to prevent the breast implant from ever touching the breast skin. Dr. Ravi uses this technique during all his silicone breast augmentations. The other being implant displacement exercises that are taught to all post-surgical breast augmentation patients by Dr. Ravi. These set of exercises help to stretch out the scar tissue that is being formed. These modalities are not always a part of a breast augmentation, but Dr. Ravi make sure to implement them in order to decrease the risk of capsular contracture. An experienced, board certified plastic surgeon who practices safely to decrease the risk of complications should be a very important criterion when choosing your surgeon. Choose someone who is diligent and takes their time during surgery by uses the latest technology as well as personally seeing all patients after surgery.

Dr. Ravi strongly believe that all patients should be educated on the possibilities of complications arising from surgery. Although there are no exact methods of fully preventing certain complications, it is important to be aware of the possibilities.

For a fully confidential consultation at Body By Ravi Plastic Surgery and Aesthetics, please call the Houston office of board certified plastic surgeon Dr. Ravi Somayazula at 282.242.1061 or fill out the online Contact Us form.