Capsulectomy for Capsular Contracture

Capsulectomy is the surgical removal of capsular contracture around the breast implant. Capsular contracture or the formation of tight scar tissue around the implants can occur in 10 to 20% of cases over the first 10 years of having the implants. The scientific causes for capsular contracture and its natural progression as well as treatments are discussed in this website.

Description

When any foreign body is accidentally or intentionally inserted into the body, the body reacts with an inflammatory reaction surrounding the foreign body. If the foreign body is no inert, the inflammatory process can continue forever. The reaction to an inert object inside the body is quite different. From pacemakers, catheters for dialysis, artificial joints to even breast implants, medical objects are routinely placed inside the human body. These medical devices are designed to contain non-reactive stable shells which do not stimulate inflammation in the body. Regardless, the body’s immune system does recognize these implanted medical devices as foreign and not made-up of our body’s unique cellular characteristic. Our body therefore forms a capsule around these objects to wall-off the object from the surrounding naturally cellular environment. You can these capsules around pacemakers and breast implants alike. In the case of pacemakers, which are make of titanium or other surgical metals, the inflammatory capsule our body forms surrounding the pacemaker is not of any significance except when removing the pacemaker. The inflammatory capsule formed around a soft breast implant is important as progressive thickening of the capsule leads to tightening of the implant. The tightening of the capsule in such cases makes the implants firm to touch and visibly deforms the breast. Termed capsular contracture, this phenomenon constitutes the most common short and long-term complication of breast implant surgery.

Cause

The specific cause of capsular contracture remains to be discovered. Theories have proposed various causes for the tightening of the body’s capsule formed around breast implant. The most commonly accepted model for the tightening suggests a systemic inflammatory or infectious process that triggers the body’s immune system. By doing so, the inflammatory cells in and around the implant capsule are stimulated to make more scar tissue around the implant, causing thickening and tightening of the capsule. Such triggers may be relatively routine activities such as tooth cleaning which does release bacteria into the bloodstream eliciting a short-term immune response to the common flu. The incidence of capsular contracture remains so low that routine prophylactic antibiotics is not yet indicated for tooth cleaning, but further research may soon prove otherwise.

Stage

i) The various degrees of Capsular contracture have been categorized into fours stages

ii) Stage 1: No visible or palpable deformity. These are essentially normal soft breast implants which are not firm to touch and do not appear deformed to the eye. More on Grade I Capsular Contracture.

iii) Stage 2: Palpable firmness of the breast implant without visible deformity. These are breast implants which have become firm to touch but are still nor visibly deformed. More on Grade II Capsular Contracture.

iv) Stage 3: Palpable firmness and visible deformity. This group of breast implants are not only firm to touch due to the tight capsule, but they also appear deformed. The deformities may include a narrower base and more projection, implants which are too high relative to the remainder of the natural breast tissue, or implants with rippling. More On Grade III Capsular Contracture.

v) Stage 4: Palpable firmness, visible deformity with associated pain and discomfort. These are patients who have a firm implant to touch with visible deformity of their breasts. Most importantly, the tight breast implant causes them to have breast pain and even tenderness to touch. By the time their pain becomes so severe that they are unable to sleep comfortably on the affected side, these patients typically turn to surgical treatment or Capsulectomy. More on Grade IV Capsular Contracture.