Capsular contracture after breast augmentation: what is dangerous and how to eliminate it

Despite the fact that breast plastic surgery is one of the most frequently performed aesthetic operations, and a huge experience has been accumulated in the installation of any breast implants, mammoplasty is still sometimes accompanied by complications that are not always possible to predict and prevent. One of the most annoying – capsular contracture after the installation of the endoprosthesis, due to which the implant is compressed, deformed, and a new surgical intervention may be required to correct the condition. How and why such a complication happens, read on our portal.

Why does contracture happen after breast augmentation

By and large, the formation of a fibrous capsule around the installed breast implant – normal reaction of the body to a foreign object, its specific protective function. Any implant, in whatever part of the body it is located (and sometimes the same happens with small objects – for example, designer parts that children put up their noses), begins to be enveloped in fibrous tissue. The formation of a fibrous membrane with a thickness of tenths of a millimeter begins immediately after the implantation of breast endoprostheses and lasts for several months, this process is not considered a complication.

However, it may happen that the walls of the formed fibrous capsule begin to thicken and calcify, the tissue becomes so dense that it compresses and deforms the implant, threatening to rupture it. In this case, we are talking about capsular contracture after mammoplasty.

The reasons why this complication occurs vary.

Depends on doctor:

• discrepancy between the dimensions of the implant and the cavity prepared for it – if the bed is not enough, then the implant will put pressure on the surrounding tissues with the inevitable development of contracture;
• implant placement under the breast – when placed intermuscularly, the capsule is better supplied with blood, less risk of salt deposition;
• Detachment of large areas of subcutaneous tissue during surgery, due to which serous fluid accumulates around the implant.

Depends on the patient:

• an individual feature of the organism in the form of an increased tendency to form scar tissue;
• intensified physical activity in the area of ​​the pectoral muscles;
• smoking;
• taking medicines that were not agreed with the doctor;
• chest injury.

Depends on the reaction of the body to the operation and the skill of the doctor:

• extensive hematoma in the implant site, which after resorption leaves fibrous tissue;
• postoperative inflammation.

Depends on the quality of the implants:

• salt implants are more likely than silicone implants to develop contractures;
• smooth endoprostheses are covered with a calcified shell more often than textured ones;
• silicone implant may rupture with penetration of substance between implant and fibrous cap;
• silicone can permeate through the implant shell and accumulate on its surface, although the latest generation of implants have special protective coatings.

Most often, the sealing of the capsule around the implant occurs due to several factors that reinforce each other. The contracture develops during the first year after the operation, although it can sometimes take several years before a complication appears.

How to recognize contracture after mammoplasty and what to do about it

The condition of the fibrous membrane around the breast implant is assessed visually and by palpation, if necessary, ultrasound or MRI is done. The norm is considered to be a thin and elastic capsule, which is soft to the touch and does not differ from the surrounding tissues. Signs of pathology:

• 2nd degree capsular contracture – the shell is dense to the touch, externally the deformations are not visible, but the edges of the endoprosthesis are palpable;
• 3rd degree capsular contracture – the implant is contoured in a calm state, bulges, asymmetries may appear, the patient complains of discomfort;
• 4th degree capsular contracture – the fibrous membrane is hard, the breast tissues are deformed, the patient feels pain, especially on palpation.

The second degree of contracture after breast surgery can be corrected by physiotherapy, massage, injections of anti-inflammatory drugs. In other cases, surgical intervention is required – either a dissection of the fibrous sheath is performed, allowing the implant to return to its normal shape, or a complete removal of the fibrous sheath with the displacement of the implant or its replacement.

In order to maximize the risk of complications after breast augmentation, a thorough preoperative assessment of the patient's health is necessary, especially in relation to the tendency to form scar tissue.

If there has been any type of surgery in the anamnesis that left behind keloid scars, it is worth discussing the advisability of breast augmentation surgery.