Beautiful breasts are the desire of many women. Today, there are many ways to achieve an attractive décolleté, even for women who were not naturally “given” this feature. One of the most traditional and common methods is breast augmentation with implants. However, like any surgery, this one can also cause complications. We spoke with a doctor from ABClinic Art & Beauty in Prague about one of the most common post-augmentation issues, capsular contracture, and about how it can be prevented.
Doctor, how many women have you helped fulfill their dream of beautiful breasts?
I’ve never counted, but there are definitely over 1,000 by now.
For many patients, the result of the surgery brings joy from graceful feminine contours, and for many, it also boosts their confidence. But what happens if complications arise? What exactly is capsular contracture or capsular fibrosis?
After the surgery, a thin layer of connective tissue, called a capsule, always forms around the implant. The body wants to “protect” itself from the implant and creates this thin membrane, which is a normal immune response to foreign bodies such as silicone implants. In most cases, this process is unnoticed, as the tissue layer remains elastic and soft, serving solely as protection for the body. However, sometimes the body reacts more intensively to the implants, forming a stronger and firmer shell around the implant. In some cases, the tissue around the implant contracts, causing the breast to harden and possibly change its natural shape. This is known as capsular fibrosis or contracture.
How often does capsular contracture occur?
The literature mentions 2-8% of cases in women who have undergone breast augmentation with implants.
What are the most risk factors for capsular contracture?
The exact causes or “triggers” of capsular fibrosis have not yet been fully clarified. However, current medicine knows of several risk factors that likely influence the development of this complication, including:
- Implant surface: Implants come in different surfaces—smooth, textured, and micro-textured. Textured or micro-textured implants have been shown to result in significantly lower rates of capsular contracture than smooth-surfaced implants.
- Implant damage (rupture): Implant rupture and silicone leakage can trigger the body’s response in the form of capsular fibrosis.
- Bleeding: This is one of the most common causes of capsular contracture. That’s why we always use drains during the surgery to remove any residual blood.
- Microinfection: A microinfection in the wound almost always leads to capsular fibrosis. It may come from the implant, surgical tools, or the surgeon’s gloves.
- Genetic tendency for scar tissue formation
- Autoimmune connective tissue disorder: This leads to an increased reaction of the body to foreign bodies, as the body defends itself. Autoimmune diseases are even a contraindication for aesthetic surgery.
- Radiation during breast cancer treatment: For patients who have undergone cancer treatment with radiation, the risk of capsular contracture is extremely high. Therefore, I recommend using their own tissue for breast augmentation (fat transfer).
- Implant position: If the implant is placed under the gland, the tactile sensation is more noticeable, and the patient may notice hardening or deformation. If the implant is placed under the muscle, it is better concealed and the breast generally feels firmer. Additionally, if we perform a reoperation after capsular fibrosis, we always place the implant in a different location than during the first surgery. If the implant was under the gland, we use a muscle placement during the second surgery. If it was already under the muscle, there are limited options for repositioning the implant.
How can I tell if I have capsular contracture after breast augmentation?
You will feel tension in the breast. The breasts will be hard, and there may be an increase in breast size. In more severe cases, there may be pain, or the breast may change shape, deform, shift, or rotate. You may also feel a hard capsule around the implant. Capsular fibrosis can affect both breasts simultaneously or just one.
The literature classifies the severity of capsular fibrosis into 4 Baker stages:
- Baker I: The breasts are soft and have a normal natural shape, which is a normal finding.
- Baker IIa and Baker IIb: The breasts are slightly to significantly firm but still retain their normal shape.
- Baker III: The breasts are firm and slightly deformed—pressure on the implant causes its deformation, shifting, or rotation.
- Baker IV: The most severe form of capsular contracture, where the breast becomes hard, often cold, and extremely painful, leading to deformation
When does capsular contracture appear after surgery?
Capsular contracture can occur as early as 2-4 weeks or up to 2 months after surgery, especially if the cause is perioperative, such as excessive bleeding, microinfection, or improper use of disinfectant solutions during surgery.
For other causes, capsular contracture may arise at the end of the implant’s lifespan, when its surface is damaged.
According to available studies, the majority (about 60%) of capsular fibrosis cases occur within the first 6 months after surgery.
Does capsular contracture always require reoperation?
No, the occurrence of capsular fibrosis does not always mean that the implants need to be replaced or removed. If it does not cause issues for the patient, there is no need for reoperation. It is also good to know that although advanced capsular contracture can be uncomfortable and painful, it does not pose a health risk.
In general, the earlier we address capsular fibrosis, the greater the chance of curing it without surgery. Only if non-surgical methods do not improve the situation is surgical intervention necessary.
What are the options for removing capsular contracture if it occurs?
Depending on the severity, there are various treatment methods aimed at loosening or surgically removing the hardened tissue around the implant. Generally, for Baker stages I-II, non-surgical treatments for capsular fibrosis can be applied. For stages III-IV, surgical removal is required.
How exactly can capsular contracture be treated?
A surgical procedure called capsulotomy is used to treat capsular fibrosis after breast augmentation. During this procedure, the doctor opens the contracted, scarred capsule and frees it from the implant, allowing the implant to regain space, expand, and return to its original shape. The breast softens again. The capsule is not removed, only loosened. This procedure is performed on patients with very thin breast tissue.
Another option is a capsulectomy, where the capsule is opened, loosened, and removed. This can be done for patients whose breast tissue is thick enough. The risk of recurrence of capsular contracture after capsulectomy is lower, but recurrence is still possible.
If capsular fibrosis reaches a higher stage, implant exchange or removal is necessary. The implant is removed along with the thickened tissue, the capsule, or at least a larger part of it. A new implant can then be placed, or the space can be filled with fat from the patient’s own body, or the breast may remain empty, and the remaining tissue can be shaped. Fat transfer eliminates the risk of recurrence of capsular contracture.
Can capsular contracture be prevented or the risk minimized?
In my opinion, yes. There are several aspects to consider in order to minimize the risk of capsular contracture. One of them is ensuring a maximally sterile environment during surgery, rinsing the implant with an antibiotic solution, and using the so-called no-touch technique, where the implant is not contaminated. The choice of implant is also crucial. As I mentioned, the risk of capsular contracture is significantly lower with textured or micro-textured implants compared to smooth implants.
The procedure should always be performed by a certified plastic surgeon with extensive experience in breast augmentation. The surgical technique should be gentle to minimize bruising and scarring. A skilled surgeon can also properly assess the appropriate placement of the implant based on the patient’s indication and the risk of capsular fibrosis—under the gland, under the muscle, or dual-plane.
Antibiotic prophylaxis during and after surgery also helps prevent infections at the wound site. To reduce the risk of capsular fibrosis, the patient should follow all prescribed post-operative care instructions carefully. This includes wearing the proper compression bra, which provides firm support and aids in healing without complications.
Prevention of capsular contracture:
- Suitable implant surface—textured or micro-textured breast implants
- Antibiotics during and after surgery
- Maximally sterile environment during surgery—no-touch technique
- Wearing the appropriate compression bra after surgery and wearing a bra without underwires for at least 6 months post-surgery
- Vitamin E
- Breast massages before surgery
Who should a patient contact if capsular contracture occurs and needs to be removed?
It is best to contact your surgeon. They generally have the complete medical records of the patient. However, it is also possible to contact other clinics with experience in the procedure. At ABClinic Art & Beauty, only certified plastic surgeons with many years of practice perform these surgeries, so we are happy to help patients who are experiencing capsular contracture.
If capsular contracture occurs, who bears the cost of its removal, and how high are the costs?
For certain implant brands, the manufacturer guarantees free implant replacement for patients who experience a higher degree of contracture within 10 years of surgery. That’s why we prefer these brands at our clinic.
What is the cost of removing capsular fibrosis?
Removing capsular fibrosis is a distinct surgical procedure. The price varies depending on whether we are only removing or loosening the capsule, or if the patient also wants the implant replaced. In that case, the surgery is slightly more expensive than the initial breast augmentation.