Capsular contracture is a complication that can occur with breast augmentation. Due to a natural but excessive immune reaction of the body, a hard tissue capsule forms around the breast implant. Improved implants and more gentle surgical techniques can significantly reduce the risk of capsular fibrosis.
What is capsular contracture?
Cross-section of a breast with a silicone implant after breast augmentation. Capsular contracture can occur in this area. See AbbreviationFinder for abbreviations related to Capsular Contracture.
Capsular contracture refers to the formation of a hard shell that encloses a breast implant. It consists of a layer of connective tissue that forms around any foreign body in human tissue as part of the normal immune system.
When this layer thickens and hardens unnaturally, it can cause severe pain and hardening of the breast. Visible deformations can also occur. In addition, with capsular fibrosis there is a risk that the implant will tear.
Causes
The cause of capsular contracture is still unknown. The formation of a thin enveloping layer of connective tissue is a regular reaction of the body to foreign material.
This serves as a demarcation between healthy tissue and potentially harmful substances. It has not yet been possible to determine why this layer of connective tissue loses its elasticity in some cases and increases in thickness. However, there seem to be some factors that favor the development of capsular contracture.
This includes the use of smooth-walled breast implants, in which capsular contracture occurs in up to 30 percent of cases after breast augmentation. The type of surgery also seems to have an impact. Capsular fibrosis occurs much more frequently when the implant is placed above the pectoral muscle than when it is placed in a pocket under the pectoral muscle.
Symptoms, Ailments & Signs
Capsular contracture can be almost symptom-free. However, the disease usually causes severe pain and visible changes in the chest area. In the first stage of the disease, the breast is only slightly hard and there are usually no symptoms or discomfort. Those affected occasionally feel a slight discomfort, which usually subsides again.
In the second stage, capsular contracture causes a noticeable feeling of tightness in the breast, which is accompanied by pain and increasing discomfort. In the third stage, the hardening can be seen externally. The feeling of tension increases and the pain intensifies. In addition, circulatory disorders and overheating of the breast can occur at this stage .
In the fourth and final stage, the breast is already severely deformed and extremely sensitive to touch. Hardening can be seen externally. Inflammation can also develop, which intensifies the symptoms of the disease and often leads to fever. The symptoms can lead to subsequent symptoms such as sleeping problems or mental problems. As a result, those affected are often irritable, tired or in a bad mood. The symptoms of capsular contracture develop insidiously and subside with early treatment.
Diagnosis & History
Capsular contracture can go almost unnoticed, but it can also lead to severe pain and visible changes in the breast. There are four stages of capsular contracture.
At stage 1, the breast is only very slightly hardened and there are no or only extremely slight symptoms. Diagnosis is by palpation and by ultrasound.
This also applies to stage two, where capsular contracture can already cause slight pain and a feeling of tightness in the breast. At stage 3, the capsular fibrosis can already be diagnosed by external appearance, since the hardening of the connective tissue cover leads to visible changes in the breast.
In addition, severe pain can occur. When capsular contracture has reached stage 4, the entire breast is hard, deformed, and extremely tender to the touch. It has not yet been scientifically clarified whether capsular contracture is related to silicone disease after breast implants.
Complications
Capsular contracture mainly occurs when the patient has her breast enlarged. Various complications and symptoms can occur after the operation. Most of those affected suffer from severe pain that occurs in the chest. This pain can spread to other parts of the body.
It is not uncommon for rest pain to lead to sleep disorders at night and can thus significantly reduce the patient’s quality of life. The breasts also tighten. It is not uncommon for the implants themselves to slip, which can also lead to aesthetic problems. Many of those affected also suffer from reduced self-esteem and are ashamed of the appearance of their breasts.
These often appear asymmetrical and have folds. Capsular contracture is usually treated symptomatically. If only pain occurs, this can be reduced with the help of medication. Possible inflammations are also limited with the help of medication.
If the symptoms are severe or lead to a severely reduced appearance, further surgical interventions are necessary in most cases. Usually there are no complications. Capsular contracture does not lead to a reduction in life expectancy.
When should you go to the doctor?
Women who have undergone breast augmentation should have their breast implants checked by a doctor at regular intervals. If there are any abnormalities or peculiarities, a doctor’s visit is necessary to clarify the circumstances. Particular caution is required in the case of hardening in the immediate vicinity of the implant. Therefore, the breast should be examined several times a month on your own responsibility. As soon as lumps or swellings are noticed, a doctor should be consulted immediately so that a diagnosis can be made using imaging methods.
If you have pain or a feeling of tightness in your chest, you should see a doctor. If you notice irregularities in turning or locomotion, report them to a doctor. The pain indicates a discrepancy that should be clarified urgently. Sudden and incomprehensible deformations of the breast or a displacement of the implant are warning signs that must be checked by a doctor. A sense of twisting or palpable structural changes in the implant must be clarified by a specialist.
Since damage to the implant can have serious health consequences, a doctor should be consulted as soon as possible. Wrinkles on the chest are also considered unusual and should be examined more closely. If the symptoms continue to increase in intensity, a doctor is needed.
Treatment & Therapy
Stage 1 capsular contracture usually does not require treatment. When pain occurs, drug therapy with anti-inflammatory agents may be prescribed.
In the case of minor symptoms, massages or an ultrasound treatment can also provide relief. Surgical treatment is essential for capsular fibrosis from stage 3 onwards.
Depending on the degree of severity, the loosening, blasting or removal of the connective tissue capsule can be considered. If the capsular contracture is already very advanced, it may be necessary to remove the entire breast implant.
Outlook & Forecast
In the case of capsular contracture, medical treatment is not absolutely necessary. Rather, it usually heals without complications and can be encouraged by hot baths and massages. This stimulates the blood circulation and thus promotes the self-healing of the body.
If there is no improvement after a few days or if pain occurs, a doctor’s consultation is essential. Depending on the degree of severity, he or she can recommend acupuncture or treatment measures from the field of Chinese medicine and support this with anti-inflammatory and pain-relieving medication. In the worst case, however, surgical removal of the capsule is necessary. Whether this is actually necessary in the individual case depends on the existing pain of the person concerned.
Affected persons should inform the doctor of all medications they are taking before an operation in order to prevent possible interactions with anesthetic drugs. After the procedure, rest and meticulous personal hygiene are indicated in order to avoid complications such as wound healing disorders or infections. Under certain circumstances, even a change in diet can be helpful, with which the doctor in cooperation with a nutritionist will be happy to help. The body needs sufficient proteins, carbohydrates, fats, vitamins, minerals and trace elements to fight off pathogens and build new skin. The better he is treated with it, the more pain-free the wound healing will be. A good supply of oxygen through plenty of fresh air is also beneficial.
Prevention
Various measures can be taken to prevent capsular contracture . In particular, when choosing a breast implant, value should be placed on a roughly textured surface, as this reduces the risk of capsular fibrosis to less than five percent.
Placing the implant under rather than over the pectoral muscle also significantly reduces the risk. Later capsular fibrosis can also be avoided with particularly gentle surgical techniques. These include avoiding skin contact between the implant and the use of drains during and after surgery, as well as flushing the implant with antibiotics. This can be supported by continuing antibiotic prophylaxis in the first few weeks after the operation.
During this time, a stable compression bra should also be worn to ensure that the implant stays in the intended place and connects well with the surrounding tissue. If all these precautions are taken into account, the occurrence of capsular contracture is very unlikely today compared to previous breast implants.
Aftercare
In most cases, those affected with capsular fibrosis have little or no direct follow-up care available. Those affected by this disease should therefore consult a doctor very early on, so that the symptoms do not worsen further. As a rule, self-healing cannot occur.
Early diagnosis can usually always have a positive effect on the further course of the disease. Capsular contracture is usually treated by taking various medications. The person concerned should always ensure that the medication is taken regularly and that the dosage is correct. If anything is unclear or if you have any questions, you should always contact a doctor first.
In severe cases, capsular fibrosis can also be treated by surgery. The patient should definitely rest after the procedure and take care of his body. You should refrain from exertion or other physical and stressful activities. The support and help of friends and family can also have a positive effect on the further course of capsular contracture. As a rule, the disease does not reduce the life expectancy of the person affected.
You can do that yourself
Capsular contracture does not necessarily require medical treatment. It usually causes no complications and resolves on its own in many cases. However, if pain occurs, a medical clarification is indicated.
The patient can support the medical therapy with various self-help measures. Massages or hot baths, for example, have proven effective. In consultation with the doctor, alternative treatment methods such as acupuncture can be tried. Chinese medicine also offers alternative measures that can resolve capsular fibrosis. In the case of larger complaints, the hardening must be operated on. After an operation, bed rest and rest apply first. The affected person may also have to change their diet in order to ensure that the surgical wound heals without symptoms.
In addition, close medical supervision is indicated. Especially after the removal of advanced capsular fibrosis, various complications can occur that must be treated at an early stage. The affected person must also ensure adequate personal hygiene in order to avoid wound healing disorders, infections and similar complaints. If, despite these measures, signs of a severe course or serious complications become apparent, the doctor must be spoken to promptly.