Capsular Contracture

What is Capsular Contracture?

A capsular contracture is the immune system’s response to a foreign object in the body; breast implants and augmentations carry the biggest capsular contracture risk factors, although other types of surgery (such as artificial joint prosthetic implants) can increase the chances. When the body tries to protect itself from a foreign object, or excess blood/bacteria are causing irritation near the implant, scar tissue or a “capsule” begins to form around the suspected offending article; though this is a normal part of the healing process following surgery, the condition can become painful if severe and require intervention. Capsular contracture symptoms can include tightening of the skin and a change in appearance around the affected area. The condition can be treated most successfully with surgery, however this may not always be required. Capsular contracture, through unpleasant if not treated, is not a life-threatening condition. 

What are the typical symptoms of Capsular Contracture?

Early signs of capsular contracture are difficult to spot, as the condition tends to develop gradually over time post-surgery. Some of the signs and symptoms of capsular contracture are listed below, and one or more of these may present with the condition:

• Pain. Following any surgery, a degree of pain can be expected. However, where it lasts for an unusually long time, it could be a sign of capsular contracture.
• Tightness. Due to the formation of scar tissue in the affected area, the skin can become tighter and feel firmer than normal. This may also reduce range of motion and therefore movement may be restricted.
• Asymmetry. A change in shape or noticeable asymmetry (for example one breast looking different to the other in terms of shape or size) may be an indication of a capsular contracture. 

The condition is ranked in four grades, known as the Baker scale, depending on the severity of the contracture, and symptoms will dictate which grade it has progressed to:

• Grade 1. The area appears normal on examination, with no evidence of thickening around the implant.
• Grade 2. There is thickening or firmness around the implant, but no change in shape and appears normal.
• Grade 3. There is a palpable capsule and hardening of the implant area, and a visible change in shape.
• Grade 4. The area around the implant is hard, painful to touch and noticeable misshapen or abnormal upon examination. 

What causes Capsular Contracture?

The cause of a capsular contracture is not always known, but it is a natural response to a foreign object being inserted into the body. It becomes problematic when symptoms do not go away or worsen, leading to the tissue becoming harder and more painful. It is thought that an irritant around the affected area, such as broken blood vessels, fluid or bacteria, can cause the contracture to occur. In other cases, a foreign object in the body can spur an instruction to the body’s immune system to encapsulate the article with fibrous tissue. It is a known complication of implant surgery and is not just limited to breast implants; pacemakers and orthopaedic joint implants also carry the risk. It’s therefore not a reflection on the quality of surgery, and can occur to anyone depending on how each individuals immune system responds. Below are some of the causes or contributing risk factors to developing a capsular contracture:

• Post-surgery complication. The most common cause, and a known risk to those undergoing breast augmentation or other implant procedures. It may also be caused by too large an implant being used which stresses the skin around it, an implant being placed on top of a muscle, or an implant rupturing.
• Autoimmune disorders. Some conditions that affect the immune system, such as lupus, can cause capsular contracture to occur.
• Trauma. Severe traumatic injury, to the breast for example, can lead to a contracture developing.
• Radiation therapy. The risk of developing capsular contracture is raised if undergoing radiation therapy. 

How to help prevent Capsular Contracture

Due to the body’s normal way of responding to foreign objects, it is not always possible to prevent a capsular contracture. The biggest preventative measure is to avoid foreign implants being inserted to the body. Where this is not avoidable, some tips are known to reduce the risk of a more severe contracture before surgery:

• Pre-surgery screening. Surgeons may screen you for underlying health conditions which may increase the likelihood of capsular contracture.
• Using appropriate-sized implants. It’s been known that where an implant is too large, a capsular contracture can be caused. In the case of breast implants, a gradual increase is recommended to avoid this.
• Textured-surface implants. A textured surface, as opposed to a smooth surface, on an implant has been proven to reduce the risk of contracture. The exact reason for this is believed to be that thicker scar tissue cannot form as easily around a textured surface.
• Implants placed under the muscle. The location of an implant plays an important part in reducing post-surgery complications, and it’s been observed that placing implants under the muscle reduces the risk of capsular contracture. 

As part of the healing process following implant surgery, massaging may help reduce the risk of developing a contracture.

How is Capsular Contracture typically diagnosed?

The diagnosis of a capsular contracture may be a physical examination, a radiography scan, or a combination of the two. A doctor will ask questions about your symptoms and use the Baker scale to grade the severity of capsular contracture by examining the area:

• Grade 1. The area appears normal on examination, with no evidence of thickening around the implant.
• Grade 2. There is thickening or firmness around the implant, but no change in shape and appears normal.
• Grade 3. There is a palpable capsule and hardening of the implant area, and a visible change in shape.
• Grade 4. The area around the implant is hard, painful to touch and noticeable misshapen or abnormal upon examination. 

An MRI scan, a painless procedure with no harmful radiation exposure, may also be required to help make a more accurate diagnosis. The images will provide a clearer insight into the size and location of the contracture. 

How is Capsular Contracture treated?

Though the severity of the condition may be treated without it, surgery is the most effective treatment for capsular contracture. There are two different operations which can be carried out:

• Capsulectomy. This procedure removed the hard tissue around the implant. Depending on the severity, the implant itself may also be removed and/or replaced.
• Capsulotomy. A procedure where the hard tissue is sliced with small incisions. This allows the capsule to expand slightly, and providing more space for the implant to move, relieving pain.

Non-surgical treatment may involve one of, or a combination of, the following:

• Aspen Ultrasound Treatment. This novel treatment option uses controlled ultrasound waves to soften the scar tissue beneath the skin.
• Massage therapy. Gentle massages may help to soften scar tissue and alleviate symptoms.
• Medications. Multivitamins and antibiotics (where a suspected bacterial infection has caused the capsule to form) may be prescribed to treat the contracture.

Is Capsular Contracture dangerous?

Capsular contracture is not a dangerous or life-threatening condition. As it’s part of the body’s natural response to foreign objects, the condition can be mild and go unnoticed. Where symptoms begin to present themselves and treatment is not sought, the scar tissue will continue to become harder and skin will become tighter. This can become very painful and lead to significant deformities after surgery. It’s recommended to speak to a doctor where symptoms begin to present, particularly if they start to interfere with everyday activities.

How can Doctify help with Capsular Contracture?

At Doctify, we are proud to work with leading specialists in all fields of medicine. Our service could put you in touch with some of the country’s leading consultants based on real patient reviews. To find the right doctor for you, visit www.doctify.com/uk.