What is capsular contracture and how can it be treated?

What is capsular contracture and how can it be treated?

Sometimes, no matter how skilled the surgeon is, complications can arise during or after surgery. Since the composition of the connective tissue varies greatly from one patient to another, the healing process is also completely unique for each patient. This is why some develop thick scar tissue after any type of deep skin injury, while others can sustain deep cuts and only develop thin scars that fade over time. Another good example of this difference is how some women develop noticeable stretch marks during pregnancy, regardless of what they do to prevent them, while other women get through their pregnancy without any problems. Additionally, the immune system responds differently to equal stimuli, and some patients’ immune systems may react poorly to medical implants. Capsular contracture is one of the most frequent complications that occur following a breast augmentation, corrective or breast reconstruction surgery. In fact, it ranks second among the reasons that lead to having to perform a second surgery. Information about it is still scarce and nebulous, but the attempts made to avoid it have led to a sharp decrease in the incidence of this disorder. Following the implantation of an internal breast prosthesis, our body reacts by developing a pouch around the prosthesis as it perceives it as a foreign body and wants to protect other tissues. In general, this periprosthetic capsule is very useful because it isolates the body and at the same time keeps the prosthesis in the correct position. It is also thin and flexible and therefore does not create problems for the patient. Discomfort occurs if the capsule thickens and contracts, tightening the prosthesis and deforming the breast. Not only will it feel hard and unnatural but it will also feel pain. This can happen after a few months or even years, or it may not happen at all. Contracture can occur in both breasts but most commonly occurs on one side only. Based on its severity we can divide the contracture into different levels. There is still a lot of uncertainty regarding the causes of the contracture of the periprosthetic capsule. A small percentage may depend on the individual healing process for which the body creates more or less thick scar tissue. Surely smoking contributes to the formation of this capsule, although it is not the primary cause. It can also result from problems relating to the implant itself (loss or oozing of gel, non-sterility of the product) but this is also a rare case, especially given the development of the latest generation of prostheses. A hypothesis that has been making its way in recent years is that of the presence of a bacterium in the breast which, instead of causing an acute infection, would develop a sort of very low-evident infection around the prosthesis that would cover it with a thin bacterial layer (Biofilm). In most cases, however, capsular contracture would seem to depend on the way in which the additive intervention is carried out and on the type of precautions that are implemented in the post-operative period. Although a way to avoid capsular contracture has not yet been identified, in recent years its incidence has significantly decreased from 20% to 2-5%. This improvement was attributed to the new intervention methods, which are increasingly safer and less invasive, and to the development of modern prostheses. To try to prevent the formation of a contracture, the following measures are currently taken: positioning of the implant in the retromuscular area, which would seem to protect the prosthesis from this complication; use of dentures with textured rather than smooth coating; use of antibiotic fluids with which to irrigate the breast during implantation; minimize the incisions for insertion in order to limit bleeding; minimize the space created for the implant in order to avoid excessive tissue damage; ensure the absolute sterility of the operating environment and the instruments used; prescription of inflammatory drugs in the early stages of the disorder.