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Michael Law MD Aesthetic Plastic Surgery

Avoiding capsular contracture

You may have heard of someone’s breast implants ‘turning hard’, or maybe you have breast implants and they are no longer (or have really never been) soft and movable like natural breasts. It is not the implants themselves that turn hard, of course; what has really happened is that the fibrous capsule which the body forms around the implants has tightened and thickened, making the implants less mobile and causing them to feel firm (and eventually, in some cases, even hard). The medical term for this phenomenon is ‘capsular contracture’.

The best approach to capsular contracture is a preventative one, and if a number of scientifically-proven techniques and materials are used when the primary breast augmentation surgery is performed, the likelihood of capsular contracture should be very low. In our practice, we rarely see patients in follow-up who have evidence of capsular contracture.

Any time a medical device is implanted in the body, whether it is a pacemaker or a breast implant or an orthopedic device or anything else, the body responds by forming a thin fibrous membrane around it. In most cases this membrane or ‘capsule’ stays thin and soft, but in some cases over time the capsule may tighten around the implanted medical device and thicken.

Since breast implants are soft objects that are placed in a relatively superficial position, capsular contracture can make a normally soft and movable breast implant feel increasingly firm, unmovable and even hard to the touch. In advanced stages of capsular contracture, the capsule can even distort the shape and position of a breast implant. Capsular contracture can be treated, but the treatment is a fairly significant surgical procedure, so avoiding capsular contracture is not just about keeping augmented breasts feeling soft and life-like, but also about avoiding another trip to the operating room.

Capsular contracture can occur on one or both sides, and while it can develop early (weeks) or late (years) after a breast augmentation surgery, in the vast majority of cases it is evident fairly early following the procedure. So the good news is that once you are six to 12 months out from your surgery, if your augmented breasts are soft and supple then they are likely to stay that way for the long term.

It has been shown scientifically that most cases of capsular contracture are primarily a response to the presence of bacteria on the implant surface that have very low ‘virulence’, which means that they are not the kind of bacteria which would usually produce an actual infection with obvious physician signs of infection such as redness, tenderness, swelling and fever.

These bacteria can adhere to the implant surface on the day that the implants are placed, and gradually become established as a bacterial ‘biofilm’ on the outer shell of the implants. The resulting low-level inflammatory response over the weeks, months and even years following the breast augmentation surgery can stimulate the cells that make collagen (called fibroblasts) to make more collagen – thickening the capsule and stimulating it to contract and tighten around the implant.

It is not an obvious infection; there are usually no symptoms that this is going on until the implant capsule tightens and changes the way that the implants feel, and taking oral antibiotics will not prevent the process or reverse it. The source of these non-virulent bacteria is thought to be the patient’s skin, or the milk duct and gland system of the breast that lead to the nipple, as both are normally colonized with low-virulence bacteria.

Because plastic surgeons have an increasingly detailed understanding of why capsular contracture occurs, there are a number of measures that can be taken to significantly reduce the likelihood that it will happen following breast augmentation surgery. Several of these techniques are discussed in the adjacent section describing ‘Dr. Law’s philosophy on preventing capsular contracture’.

Read DR. LAW’S PHILOSOPHY on PREVENTING CAPSULAR CONTRACTURE

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