Breast Series Part Three...Capsular Contracture Explained By Michael A. Devlin, MD on March 30, 2015

If you’re confused by this word, don’t worry. The term Capsular Contracture does sound very intimidating. If you have breast implants or are considering implants, it’s important that you have an idea about what this medical term means.

Dr. Michael Devlin in Little Rock, Arkansas has performed thousands of breast augmentations since 2001 and takes extreme precautions when placing breast implants. He wants his patients to be informed prior to their surgery on complications that could arise.

Capsular Contracture

After a breast augmentation the body reacts to the implants by forming a protective lining around it. This is referred to as the "capsule”. In some women, for reasons we don't understand completely, the capsule has a tendency to shrink, squeezing the implant. This is referred to as capsular contracture. Capsular contracture is the term used to describe scar tissue that can form around breast implants which may cause the breasts to harden, look or feel different, and may cause some discomfort. Capsular contracture is an unpredictable complication, but it is also the most common complication following breast augmentation

Mentor and Allergan (the two biggest manufactures of breast implants) show a capsular contracture rate of 7-15% based on a 7 year study. These are pretty significant odds. Most capsular contractures happen within the first year. However, once you reach the golden year mark, you still need to have regular breast exams to check your breasts. The odds of developing a contracure increase each year so that approximately 16 out of 100 will develop this at some point during the time they have implants.

What are the Signs and Symptoms?

There are different degrees of capsular contracture. The most common grading system is the Baker classification stages I-4

Grade 1 This is the ideal breast implant. There is no hardening at all. The breast feels and looks soft.

Grade 2 The capsule has thickened a little but it is not a problem. It looks normal but is slightly more firm than normal tissue.

Grade 3 The implant is clearly firm to the touch and usually has become rounder. The breast may begin to look higher. Pain may or may not be present.

Grade 4 This is where the implant is not only hard, round, and elevated but it is usually painful.

What can be done if you develop a Capsular Contracture?

Massage

Mild cases of capsular contracture are typically treated conservatively with massage. However, over aggressive massaging can cause the implant to be displaced. You will be instructed on proper massing techniques.

Medication

Often times, medication will be prescribed. Accolate and Singulair are two drugs in a class of drugs used to treat asthma called leukotriene inhibitors (LTI). These medications appear to effectively soften early capsular contracture and may prevent the formation of capsular contracture in those patients at risk.

Surgery

If the breast has progressed to a Grade 4 contracture, a surgical procedure is often required.

A Capsulotomy is a minor procedure. It involves making several incisions usually at the bottom of the breast capsule to allow the implants to drop. The capsule is not removed. It is simply cut and allowed to expand.

A Capsulectomy is a bigger procedure. It involves removing the entire capsule and replacing the implant.

Unfortunately, medical studies have shown that any woman who undergoes revision surgery for a previous capsular contracture is at greater risk of recurrent capsular contracture following subsequent surgeries of the breast. Therefore, Dr. Devlin will follow these patients closely.

Are implants guaranteed against capsular contracture?

Good news! As of October 2014 Mentor, for the first time ever, has an extended warranty program that now covers capsular contractures for up to 10 years! For $200, the extended warranty covers the surgeon’s fees, anesthesia, surgery center fees and implants. We recommend purchasing this warranty for any patient undergoing breast augmentation.

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If you have further questions about capsular contractures please contact