Anytime a foreign object is implanted, the body responds by developing a lining around the object. This is the body’s attempt to separate itself from a foreign object.
When a breast implant is inserted it naturally forms this lining which is called a capsule.
Normally the capsule is thin and pliable enough to allow for natural movement of the implant throughout the pocket.
In some cases, this capsule can become thick and firm. It can then contract becoming smaller and compressing the implant. This is called a capsular contracture. This results in a firmer breast which in more severe cases can actually lead to visible distortion.
Although much research has been performed over the last 30 years, causative agent of this problem remains somewhat elusive. We do know that in many cases the common factor is some type of inflammatory process. This may be secondary to a subclinical infection. A subclinical infection isn’t severe enough to cause external signs of infection such as fever or redness infection, but enough to create an inflammatory process in the pocket. If the patient has some bleeding into the pocket after surgery it can lead to an inflammatory process that can lead to a contracture.
In order to prevent a capsular contracture it is important to make sure that the patient is in good health pre-operatively and take great care to prevent post-operative infection and bleeding. We also know that placing the implant underneath the muscle layer results in a significant decrease in the incidence of capsular contracture.
Even with all of these precautions it is still possible to have the problem.
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.
Over the years, many procedures have been promoted to treat and establish a contracture. This might include removal or release of the capsule with placement of a new implant, or placement of the implant in a different tissue layer.