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Every woman desires to have a bust that complements the natural contour of her body. From push-up bras to enhancement cream, women have always looked for ways to improve the size and shape of their breasts. And among these methods, breast implants have been the most successful at enabling women to shape their body to their desires. These medical devices are implanted into the chest, either under the breast tissues or the chest muscles in a procedure known as breast augmentation.

Having breast implants is a personal decision and its benefits should be weighed against its potential risks and complications. One of the most common yet serious problems that should be considered before undergoing the procedure is capsular contracture.

encapsulated breast implants

Capsular Contracture and its Signs

Capsular contracture occurs when the internal scars from a constricting capsule around breast implants. The formation of scar tissue is a natural reaction of the immune system to the placement of any foreign objects into the body. However, its development becomes problematic when the scar tissues begin to contract and limit the movement of the implants.

The slow progression of capsular contracture makes its signs and symptoms difficult to detect. It can happen any time after having the procedure, but usually, it is observable within the first six to nine months following breast implant surgery. Common signs of having encapsulated breast implants include:

  • High-riding breasts, which is caused by an unusually higher position of the implant in the chest
  • Breasts appear smaller, ball-shaped, and somehow deformed
  • Unusual hardening and tightness of the implants that can be painful at times

Diagnosis

A thorough physical examination is necessary for the diagnosis of capsular contracture. Its symptoms are categorized according to grades in a system called the Baker Classification of Capsular Contracture. This system has four (4) grades:

Grade I: There is no detectable capsule around the implants. The breasts feel soft and look natural. There is no need for any treatment at this point.

Grade II: The breasts still look normal but there is a slight firmness upon palpation. Doing breast massages and taking prescribed medications can help improve the condition.

Grade III: The breasts have moderate hardness and distortion. Surgery is necessary to have the condition corrected. Otherwise, this grade can progress to the next stage.

Grade IV: This is the most severe condition due to the pain and tenderness resulting from the contracture. The breasts are abnormally deformed and surgery is necessary to correct the contracture.

What Causes Capsular Contracture?

Encapsulated breast implants have always been a risk in breast augmentation surgeries. The actual cause of capsular contracture remains unknown, although studies suggest that it is due to excessive bleeding and low-grade bacterium‘s biofilm formation on the surface of the implant.

Preventing the Development of Capsular Contracture

  • No-Touch technique
    To lower the possibility of having capsular contracture from bacterial sources, administration of perioperative antibiotics and antibiotic irrigation can be done prior, during, and after the surgery. A No-Touch technique may also contribute to decreasing the chance of contaminating the implants, incision sites, and tissues. Avoiding direct trauma to the ribs and surrounding tissues also helps in preventing excessive bleeding and lessens the formation of scar tissue capsule around the implant.
  • Sub-muscular placement
    Sub-muscular placement of the implants can help reduce the risk of capsular contracture. This placement allows implants to move within its pockets through the action of the pectoral muscles that mimics breast massages. The space resulting from the movements can prevent the scar tissue capsule from tightening around the implants.
  • Postoperative instructions
    Lastly, following postoperative instructions such as massaging the breasts and refraining from lifting heavy weights is also necessary for minimizing breast implant encapsulation and other complications.

Your Guide to a Safe and Satisfying Result

Having a zero rate of breast implant encapsulation is close to impossible. But its occurrence is greatly lessened with the preventive measures that plastic surgeons expertly apply prior to surgery and upon developing the complication.

The breasts are the most defining feature of the female form and it is important that they retain their function and aesthetic appeal through breast augmentation. With the guidance of a board-certified plastic surgeon, women are assured that the procedure is safe, satisfying, and life-changing.

About The Author

Cara Downey, MD

Board-certified plastic surgeon Dr. Cara Downey provides cosmetic surgery procedures to Houston and the surrounding areas.

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  • Is encapsulation of prosthetic breast implants a type of procedure or is it a complication/diagnosis from breast augmentation?
    Thank you
    Marzena

  • Encapsulation of a breast implant is an expected response from the body to any foreign object placed. It is not a complication. Capsular contracture is excessive encapsulation causing firmness, distortion, and/or pain, which is a complication of breast implantation. The procedure to help alleviate this would be a capsulotomy(breaking/cutting) or partial/full capsulectomy (removal).

  • I had breast implants for 22 years with absolutely no problems at all. I decided that perhaps it was time to change them out and go with a slightly bigger implant. Within one year I could tell one was changing shape and taking on a firmness. Both times I had the implant on top of the muscle. My certified plastic surgeon now says that best option would be to replace and to have a much better chance of not happening again is to go under muscle. Says basically starting from scratch and wants $6500, does he have no culpability? I also think one may be ruptured and he said that right after I had my surgery he stopped using that brand because they had a high rate of rupture that had been reported.

    • Capsular contracture, unfortunately, is a complication of implant surgery that is more common with sub-glandular implantation. Ideally, a plastic surgeon should educate every patient on the risks and complications associated with implant surgery. Aside from education there is nothing a board certified plastic surgeon can do to prevent capsular contracture. I would agree that reimplantation under the muscle is a sound plan.

  • I am on my second set of breast implants. My first set I got the capsular contracture. So had removed and done again. I now have it again. Have not gone to the surgeon yet to get looked at. But in the meantime just got my first mammogram done and got a call to see doctor. Could the capsular contracture be mistaken for cancer or something else? And if all is good and I get them redone is it most likely to happen again? Am I prone to this? Would it be better to have my own fat tissue put in instead of the implant?

  • Do mammograms increase risk of rupture?

  • Hi,
    I had my implants done in 2004 and by 2009 I stared to have foot pain. No meds no cortisone shot helped me the long way. To make long story short, I just remove my implants to have a smaller size and because of the encapsulation problem and I wanted a smaller size but when my surgen saw what was inside of me decided to clean me up and closed the open and talked to me after I woke up. I was in bad shape he said and he made the best decision to not place the new one in. My story is that the implants were the cause of my foot pain. Know I am back to a smaller breast size but my feet don’t hurt anymore. That’s the most important thing for me know, my health….No more implants for me.

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