Breast augmentation can give great results. However, it also carries some risks which can lead to unfavourable results and complications.
Capsular contracture is the most common complication associated with breast augmentation and can happen at any time, but seems to be more common in the first several months after surgery.
Hos does Capsular Contraction occur?
At the time of the initial surgery, a pocket is made for the implant. During the healing process, a capsule forms, which is made of fibrous tissue. The body is programmed to shrink scar tissue somewhat. Under normal conditions, the pocket remains open, allowing the implant to look and feel natural. However, in some people, the capsule will tighten, and squeeze the implant. This makes the breast implant feel hard, and distorts the appearance of the breast. In the later stages, the implant feels very firm, and may take on a ball-like look. Capsular contracture usually produces pain and discomfort.
What causes capsular contraction?
The exact cause of capsular contracture of breast implants is unknown. There are some factors, however, that may increase the risk of capsular contracture.
This decreases the oxygen levels in the blood, which may result in delayed healing, and possibly an inflammatory reaction.
Capsule contracture seems to be more likely following an infection.
If you have had seroma, you may be at more risk for capsular contracture.
- Sub glandular placement
Breast implants placed above the muscle tend to have higher capsular contracture rates, versus breast implants placed in behind the muscle, also known as submuscular placement.
This can cause an inflammatory reaction, which can lead to capsule contracture.
4 grades for capsular contractor
- Grade I
Breast is normally soft and looks natural
- Grade II
Breast is a little firm but looks normal
- Grade III
Breast is firm and looks abnormal
- Grade IV
Breast is hard, painful, and looks abnormal
What is involved in correcting capsular contraction of breast implants?
When a patient develops capsular contracture there are techniques that can be used to solve the complication.
There are two ways to reduce the firmness of a contracture. These are the open and closed capsulotomy. In the closed capsulotomy, the hardened implant is manually squeezed tightly from the outside, in an attempt to tear the scar envelope. When successful the result is instantaneous and the implant immediately feels soft.
The tear resistance of the scar envelope however varies from patient to patient. Some tear easily but others the scar is so hard that it cannot be torn. In some, only a partial tear is possible which can lead to an unsightly appearance. A closed capsulotomy can also result in bruising, bleeding, or even rupture of the implant itself. If rupture does occur then you will need surgery to remove and replace it, due to this, closed capsulotomy is the less favourable method.
The most successful and most used method for capsular contracture is open capsulectomy, whereby the surgeon makes an incision to enter into the pocket and make cuts into the scar tissue. These cuts are made to release tension around the implant caused by capsular contracture. The implant is then reinserted again into the breast pocket. Unfortunately, even after a successful capsulectomy, there is always the possibility of recurrent hardening.
This procedure is carried out under general anaesthesia and may require an overnight stay in hospital. It can be painful afterwards, especially if the implant has been moved under the muscle. Drains are left in the breast pocket overnight and removed the following day. Sutures are removed 7-10 days post-operatively. Swelling may last for several weeks and if surgery has been necessary on one side only, this will cause temporary asymmetry as a result of swelling.
You will feel tired and sore for a few days and will have slight swelling and bruising which is only natural. Most of your discomfort will be subsided with prescription medication. Following the operation you will have a light dressing in place which will need to be kept dry for 2 weeks. After 2 weeks your dressing will be removed and the wound inspected and lightly cleaned. The scars will be firm and pink for at least six weeks and may remain the same size for several months and it is important to keep in mind that they may take up to 2 years to fade. You will have follow-up visits in the months after surgery to check on your progress.
This will depend on the individual patient however most patients are able to go back to work after a couple of days. Although you can walk about and do very light activities from the next day it is advisable not to do anything strenuous for 7-10 days. The average recovery time is between 1-2 weeks.