Guide to Breast Implant Capsular Contracture: Grading, Avoidance, and Treatment

Introduction

Breast augmentation is one of the most popular cosmetic procedures worldwide, offering women the opportunity to enhance their self-confidence and achieve their desired aesthetic goals. While the majority of breast augmentation procedures are successful, complications can arise, and one of the most common complications is breast implant capsular contracture. In this blog, we'll delve into the details of capsular contracture, including its grading system, strategies for avoidance, and available treatment options.

Understanding Breast Implant Capsular Contracture

Breast implant capsular contracture occurs when the natural scar tissue (capsule) that forms around the breast implant begins to tighten, leading to various degrees of discomfort, distortion, and pain. This condition can affect one or both breasts and is graded using the Baker Scale, which consists of four grades:

Grade I: The breast feels soft and appears normal.

Grade II: The breast feels slightly firm but looks normal.

Grade III: The breast feels firm, looks distorted, and may be uncomfortable.

Grade IV: The breast feels hard, appears severely distorted, and is often painful.

Preventing Capsular Contracture

Prevention is the best approach when it comes to breast implant capsular contracture. Although it's impossible to eliminate the risk entirely, there are several strategies that can help reduce the likelihood of developing this condition:

No touch technique: The breast implant as an implanted device can inadvertently have some skin bacteria on the surface if care is not taken during placement.  Changing gloves and instruments, introducing the implant with a sleeve (Keller Funnel, Inplant, etc), and using protective film over the areola and skin incision.  Our current understanding of capsular contracture is that chronic inflammation from a subclinical bacteria such as staph epidermis can lead to the capsule remaining thick and contracting.

Antibiotic Irrigation: Irrigating, or washing, the implant pocket and implant with triple antibiotic and betadine can be used to decrease the chance of any bacteria remaining in the pocket or on the implant surface.

Hemostasis: Careful creation of the implant pocket without bleeding is necessary to eliminate space for bacteria to proliferate.  Bacteria can proliferate in setting where old blood is collected as antibiotics are not delivered to the center of these collections.

Implant Placement:  Older studies suggest implant placement in the under muscle position may have a lower risk of capsular contracture.  Studies that incorporate modern techniques of capsular contracture reduction strategies do not show as significant difference in capsular contracture rates.

Implant Surface and Type: Implants with textured surfaces, have shown a lower incidence of capsular contracture compared to smooth-surfaced implants. Silicone implants tend to have a lower rate of contracture than saline ones.  Textured implants however have been shown to have some implant associated malignancies at higher rates compare to smooth.

Size Matters: Avoid selecting implants that are too large for your body frame. Larger implants may put more strain on the surrounding tissue, increasing the risk of contracture.

Incision Technique: The incision site can also play a role. Inframammary and periareolar incisions are often preferred over transaxillary and transumbilical approaches due to a potentially lower risk of complications.

Treatment Options for Capsular Contracture

If you suspect or have been diagnosed with breast implant capsular contracture, there are several treatment options available, depending on the severity of your condition:

Non-Surgical Approaches:

Medications: Your surgeon may prescribe medication like Singulair (montelukast) or vitamin E to help alleviate symptoms and reduce inflammation.

Physical Therapy: Gentle massage and breast exercises may help soften the capsule and alleviate discomfort.

Surgical Options:

Capsulotomy: In mild cases (Grade I or II), a capsulotomy involves making incisions in the capsule to release the tightness and improve breast shape.

Capsulectomy: In more severe cases (Grade III or IV), a capsulectomy may be necessary, which involves removing the entire capsule along with the implant and replacing it with a new one.

Implant Exchange: In some instances, simply replacing the implant with a new one may resolve the issue.

Conclusion

Breast implant capsular contracture is a common complication that can affect individuals who undergo breast augmentation. Understanding its grading system, adopting preventative measures, and exploring treatment options with your plastic surgeon can help you navigate this condition effectively. Remember, early detection and proactive management are key to achieving the best possible outcome, and consultation with a board-certified plastic surgeon is crucial in addressing your specific situation.