Capsular Contracture: What Is It?


Valerie DeBenedette, Senior Medical Editor

Valerie DeBenedette is a science writer who specializes in keeping people informed about medicine and their health. She has more than 20 years of experience writing for newspapers, magazines, and websites and has written about most areas of medicine. For many years, she was a contributing writer to Cosmetic Dermatology and to Drug Topics, the leading pharmacy trade magazine. She also was a contributing editor to The Physician and Sportsmedicine for many years. She has written about most fields of medicine, including dermatology, sportsmedicine, ophthalmology, general surgery, orthopedics, and women's health; as well as public health policy and the pharmaceutical industry. In addition, she is the author of Caffeine, a book for young people. She is a member of the National Association of Science Writers.

November 28 2007

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The majority of breast augmentation procedures end up one way: with a happy patient who is pleased with her breast implants and loves her improved silhouette. However, there are adverse reactions that can occur with breast implants, and one is capsular contracture, occasionally abbreviated as CC.

Essentially, capsular contracture is excessive scar tissue that forms around the implant. With almost any foreign item placed in the body, from a splinter to an artificial joint, the body's natural reaction is to either try to get rid of it or form scar tissue around it to wall it off from the rest of the body. The formation of some scar tissue around a breast implant is normal and natural.

It is when scar tissue becomes excessive and hardens—squeezing the implant—that it becomes capsular contracture. Capsular contracture can be painful and disfiguring. The breast can become hard and shriveled or unnaturally round in severe cases. Very severe contracture can lead to rupture of the implant. Capsular contracture rarely resolves by itself, and it can require additional surgery to correct.

No one knows why one person will develop the problem and the next does not. Some patients will have problems with their first set of implants, but not the second, or vice versa. You can even develop contracture in one breast, but not the other.

Most patients who develop capsular contracture start having symptoms around 3 months postoperatively. However, you can develop capsular contracture at any time if trauma to the breast or an infection occurs.

Many surgeons believe certain factors increase your chances of developing capsular contracture. These include infection, developing a hematoma or seroma, radiation therapy, severe trauma to the breast, silicone gel leaking from the implant, and having an autoimmune disorder.

Do I Have Capsular Contracture?
If your breasts seem deformed, misshapen, and have become painful, or if they have become firmer than when you first got them, you may have developed capsular contracture.

There are four grades of capsular contracture. In Grade I, the breast is soft and looks natural. In Grade II, the breast is a little firm, but still looks normal. In Grade III, the breast is very firm and has started to look visibly distorted. In Grade IV, the breast is hard, painful, and definitely looks abnormal, with greater distortion.

Can You Prevent Capsular Contracture?
Textured implants were developed to help prevent capsular contracture. However, there is little evidence that the texture of the shell makes a difference. Many surgeons believe capsular contracture happens less frequently when the implants are placed under the muscle, since the almost constant movement of the muscles prevents hardening and contraction of the scar tissue.

Some surgeons believe you can help prevent capsular contracture with massage or pocket quadrant exercises on your implants. Then again, some think these exercises are a waste of time. Quadrant exercises are where you push the implant up, down, and to each side. You may be told to do this a couple of times a day and hold your implant in each position for a few seconds. Your surgeon should show you how to perform these exercises—assuming your surgeon thinks they are a good idea in the first place.

Because having dental work can spread bacteria into the bloodstream and lead to an infection, some surgeons tell their implant patients to premedicate with a dose of an antibiotic before having any dental work done. This practice is common for people with other medical implants such as artificial joints and heart valves.

What Can Be Done About Capsular Contracture Once You Develop It?
There are treatments for severe capsular contracture, but they may not be pleasant. Some surgeons still attempt to remedy the problem by squeezing your breast and implant hard to break up the capsule. This can result in pain, possible rupture of the implant, and bleeding in the breast. Forcibly compressing the implant is not recommended for saline implants.

Some surgeons treat capsular contracture with injections of corticosteroid drugs, such as prednisone. Some surgeons recommend prednisone shots, vitamin E, and manual compression. Serious cases of contracture require surgery either to break up the scar tissue or to remove the implant and the scar tissue.

New technologies are being developed to treat contracture, including external application of ultrasonic energy waves.