What is capsular contracture and how can it be treated?
Sometimes, no matter how skilled the surgeon, complications can arise during or after surgery. Since the composition of connective tissue varies greatly from one patient to another, the healing process is entirely unique. This explains why some people develop thick scar tissue after deep skin injuries, while others form only thin scars that fade over time.
Another example is how some women develop noticeable stretch marks during pregnancy regardless of preventive measures, while others experience none. Similarly, immune systems respond differently to identical stimuli, and in some patients may react poorly to medical implants.
Capsular contracture is one of the most common complications following breast augmentation, revision, or reconstruction. It ranks second among the reasons requiring a secondary surgery. Information is still limited, but prevention efforts have significantly reduced its incidence.
After a breast implant is placed, the body forms a periprosthetic capsule: generally useful for isolating the implant and keeping it in place. Normally thin and flexible, it may sometimes thicken and contract, squeezing the implant and deforming the breast. This not only makes the breast feel hard and unnatural, but can also cause pain. It may appear within months, years, or never. Contracture may affect one or both breasts and is graded by severity.
Causes remain uncertain. In some cases, it depends on individual healing response. Smoking contributes to capsule formation, though not as a primary cause. Rarely, issues with the implant itself (gel leakage, lack of sterility) are involved, though much less likely with modern devices. A recent theory links capsular contracture to a bacterial biofilm, which may cause a low-grade infection around the implant.
In recent years, the incidence of capsular contracture has fallen from 20% to 2–5% thanks to improved surgical methods and advanced implants.
Current preventive measures:
- placing the implant in a submuscular pocket
- using textured implants rather than smooth
- irrigating the pocket with antibiotic solutions during placement
- minimizing incision size to reduce bleeding
- creating the smallest possible pocket to limit tissue damage
- ensuring strict sterility of instruments and environment
- prescribing anti-inflammatory medication in the early stages
