Capsular contracture occurs when the scar tissue or capsule that normally forms around the implant tightens and squeezes the implant. Capsular contraction is more common following infection, hematomas or seromas (collection of watery portion of blood). There are four grades of capsular contracture The Baker Grades I through IV are: Grade I - the breast is normally soft and looks natural; Grade II - the breast is a little firm but looks normal; Grade III - the breast is firm and looks abnormal (visible distortion); Grade IV - the breast is hard, painful and looks abnormal (greater distortion).
Feels Firmer
If the breast implant of a patient feels firmer than before or the breast shape changed the patient probably has a capsular contracture of the breast implant. Breast implant capsular contracture is the most common reason for additional breast surgery after breast augmentation. The body elicits an inflammation reaction producing scarring around the implant. The scarring can then progress and produce capsular contracture or tightening of the scar tissue around the breast implants. Several factors increase the risk for capsular contracture: infection, bleeding around the breast implants, talc or other powders around the implants and a silicone bleed or rupture. The best way of avoiding capsular contracture is to minimize the above risk factors and have a follow up exam with the doctor.
Capsular Contracture Occurance
Immediately after a doctor inserts a breast implant into the breast pocket, the body begins forming scar tissue around the implant. The scar tissue is a way for the body to separate or encapsulate the foreign breast implant from the body. Over a short to a long period, the scar tissue may thicken. As it does so, the tissue around the breast tightens, making the breast appear round, feel firm and possibly cause the patient pain. The four grades of capsular tightening or contracture begin with Grade I, which is essentially a normal, soft implant. Grade II describes an implant that is firm to the touch, but still appears normal. A Grade III implant is visibly and palpably firm. The last grade or Grade IV describes an implant that is visibly and palpably firm and causes the patient pain.
Prediction
Doctors cannot predict the occurrence of symptomatic capsular contracture. The overall rate of capsular contracture is 10 to 20 percent over 10 years after the doctor inserts the implant. Overtime doctors estimate the occurrence of capsular contracture to rise. Capsular contracture may occur in one breast pocket, both or neither. Capsular contracture occurs more often when a doctor places an implant in front of the chest muscle. Treatment for capsular contracture may require surgery, implant replacement or implant removal. Capsular contracture may reoccur and doctors notice that revision augmentation causes capsular contracture more often than primary breast augmentation.
