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Breast Implant Capsular Contracture

By Brian Kobienia, MD, FACS on November 01, 2011


Capsular Contracture

What Is It?

The most common problem women have with their breast implants is the development of a scar, or encapsulation, around the device.  When this tightens around the implant it is known as capsular contracture.

Who Gets It?

To be blunt, everyone gets it to some degree.  Anyone who has a foreign object in their body, whether it be an artificial knee, a pacemaker, breast implant or a sliver in the finger, will develop a scar around that device or foreign object.  Most of the time this is a good thing.  Without the scar process holding in the hip or knee implant can you imagine the problems?  The difficulty for the breast implant is that we typically want the device to remain soft so the breast feels natural. 


Why Do We Make Scars?

Scarring is simply the mechanism of the body to heal injuries.  Without the ability to scar our bodies would be open to infection because wounds wouldn’t heal.  We assume the body is going to scar after a surgery or an injury.  If too much scar is made or if the scar contracts in an undesirable way a problem develops.  When a scar develops around the implant it tends to tighten.  This will change the characteristics of a breast implant that has a fluidity of shape and tighten it until the implant has the smallest surface area possible.  This shape, if you remember high school physics, is a sphere.  The breast naturally does not look like a sphere.  Having a spherical implant behind the breast makes the breast look unnatural not to mention the uncomfortable firmness.


What Can You Do About It?

An ounce of prevention may be the key here.  One of the reasons we place the implant beneath the chest (pectoralis) muscle is to minimize the chance of the scars tightening around the implant.

If you develop a tightening of the scar around the implant generally it can be managed by surgically releasing the scar or removing it altogether.  Yes this is surgery, but is usually pretty minor.  If you develop the capsular contracture very early after the placement of the implant (within weeks) active massage and the use of certain medicines may have some benefit.

When Should You Fix The Capsular Contracture? 

Quite honestly there is no absolutely correct time to do surgical correction of capsular contracture.  I recommend the surgery when conservative maneuvers have failed and/or when the discomfort bugs the patient.  This surgery is usually done as an outpatient under anesthesia.  We no longer recommend closed capsulotomy (manually squeezing the breast and scar until the scar breaks).  Although this maneuver would give immediate softness to the breast it would also potentially break the implant.

Can You Expect To Never Get A Capsule?

Technically, I think the answer to that question is no.  Everyone who develop a scar around the breast implant has developed a capsule.  It just hasn’t contracted yet.  Unfortunately, I think given enough time everyone will get some degree of contraction of the breast implant capsule.  Typically, this happens years after the implant is placed.  So do you need to be overly worried about capsular contracture?  In my opinion, the answer is no.

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