After an implant is placed in the performance of a breast augmentation the body forms a lining around the implant creating a barrier between the foreign object and the rest of the body. Normally this barrier is thin and soft and does not create any change in the appearance or feel of the breast. This lining is called a capsule. If this capsule thickens, becomes harder and shrinks in size the breast will feel firmer and possibly change shape. This shrinkage and or thickening of the capsule is called a capsular contracture. 92% of capsular contractures will occur within the first 12 months following surgery. Although the exact cause for a capsular contracture is not well understood there are a few things that seem to be related to this phenomena.
Implants placed under the muscle have a lower incidence of capsular contracture than implants placed above the muscle. If bleeding occurs in the pocket after a breast augmentation, and is not removed the accumulated blood will gradually be broken down. As the blood is broken down inflammation occurs in the pocket which can then lead to the formation of a capsular contracture. Any type of infection in the pocket can cause inflammation leading to a capsular contracture. The infection may be “subclinical”. A subclinical infection is a minor infection which does not cause symptoms beyond the affected area.
There are several different treatment options for an established capsular contracture. Many surgeons feel that it is important to create a site change and replace the implant with a new one. A site change refers to moving the implant to a new pocket location. For instance if the implant had been placed underneath the breast tissue the new pocket is made under the muscle layer. If the implant was originally under the muscle it can either be placed under the breast or in what’s called a” neo-pectoral pocket”. A neo-pectoral pocket is developed by temporarily removing the implant and creating a new pocket behind the back wall of the capsule surrounding the implant. The implant is then placed in this new pocket. Most surgeons agree that it is also important to put in a new implant when treating capsular contracture. This is due to the possibility that the old implant is covered by “biofilm”. Biofilm is thought to be one of the causative agents for capsular contracture. Biofilm is a barrier that forms around some implants possibly secondary to a subclinical infection. A subclinical infection is one that affects the breast implant pocket but does not cause any other external symptoms.
One of the simplest ways to release a capsular contracture is by performing a capsulotomy. In the performance of a capsulotomy the previous incision is opened, the implant is removed and the capsule is then cut in several different locations to release the constrictions allowing the pocket to open up and return to its original size. The original implant is replaced with a new one and the wound is closed. In the past, however this procedure has been associated with a relatively high rate of recurrence.
Most plastic surgeons believe that post-operative massage can help keep the pocket open and hopefully prevent a contracture. This massage should be undertaken after healing is finished so as not to disrupt the result of the surgical procedure. Some doctors will recommend a course of vitamin E for several months to help subdue inflammation.