How does capsular contracture develop?

After breast implant surgery, the body forms a thin layer of scar tissue around the implant as a natural reaction to a foreign object. In some cases, this tissue can thicken and contract, leading to capsular contracture.

Some possible causes are:

Infection: Even subtle, unnoticed infections can cause excessive scar tissue to form.
Haematomas or seromas: A build-up of blood or fluid around the implant can increase the risk.
Immune reaction: The body can overreact to the implant.
Quality of the implant: Implants of lower quality or with a rough outer layer may have a higher risk of contracture.
Placement of the implant: Implants placed above the chest muscle appear to have a slightly higher risk.

Symptoms of capsular contracture

The symptoms of capsular contracture can vary in severity and are often classified into four stages, known as the Baker classification:

Grade I: The breast feels soft and looks normal.
Grade II: The breast feels slightly firmer, but there is usually no distortion.
Grade III: The breast is hard and distorted, often with visible asymmetry.
Grade IV: The breast is hard, distorted and painful.

In the early stages, many patients notice only subtle changes, such as increased firmness or slight tenderness. In advanced cases, pain, discomfort and aesthetic problems can occur.

Diagnosis of capsular contracture

A doctor can usually diagnose capsular contracture based on a physical examination and the patient's medical history. In some cases, additional imaging, such as an ultrasound scan or MRI, may be recommended to assess the severity of the contracture and rule out other causes.

Treatment of capsular contracture

Treatment depends on the severity of the capsular contracture and its impact on the patient. Options include:

Non-surgical treatments

Massage and compression: In mild cases, a doctor may recommend massaging the breast regularly.
Medication: Medication such as leukotriene inhibitors (e.g. Singulair) can sometimes be used to soften the scar tissue, although its effectiveness is limited.

Surgical treatments

Capsulotomy: In this procedure, the surgeon makes incisions in the capsule to give the implant more space. The capsule itself stays in place.
Capsulectomy: This is a more extensive procedure in which the entire capsule is removed. This is often combined with replacing the implant.
Removal of the implant: In some cases, especially with recurrent contractures, patients choose to have the implants removed completely.

Prevention of capsular contracture

Although capsular contracture cannot always be prevented, there are steps that can reduce the risk:

Use of antibacterial protocols: Reducing the risk of infection during the operation is crucial.
Placing the implant under the muscle: This appears to lower the risk.
Choosing high-quality implants: Smooth implants or implants with a certain texture have a lower risk.
Minimal manipulation: Avoiding excessive movement of or pressure on the implants in the early recovery period.

Prognosis

Most cases of capsular contracture can be treated effectively, especially if they are detected at an early stage. It is important to have regular check-ups after breast implant surgery and to report any changes in the breast to a doctor straight away.

After a well-performed corrective procedure, patients usually recover fully and the results are long-lasting, although there is always a risk of recurrence.

Want to know more? Read more about breast treatments or Breast augmentation at Kliniek het Bolwerk.