Breast Augmentation Capsular Contracture Symptoms

If you notice changes in the shape or feel of your breast, it might be time to talk to your doctor. There are all kinds of reasons why this could happen, and it pays to rule out any serious causes before proceeding with treatment.

In this guide, we review the aspects of Breast Augmentation Capsular Contracture Symptoms, is capsular contracture dangerous, does capsular contracture get worse, and how to break up scar tissue around breast implants.

Breast Augmentation Capsular Contracture Symptoms

When I was younger, I remember the first time my mother told me about breast augmentation. She had implants put in when she was in her 50s and said that they were like having her youth returned to her. They made her feel sexy again and gave her confidence.

As someone who loves all things beauty, I’ve always been intrigued by the idea of having my own breasts augmented. But every time I brought it up with my doctor or friends (who also have implants), they would tell me how painful it was going under the knife again and how much recovery takes out of you physically and emotionally.

Yet here we are: Almost 20 years later, this woman has had two more children since her last breast augmentation surgery—and still feels just as confident now as ever before! What changed?

• **

Changes in how your breast looks or feels

You may notice changes in the way your breasts feel and look.

• Your breasts may feel firmer than before.
• One breast may feel firmer than another.
• Your breast(s) could feel hard to the touch, as if there is a tight band around it.

Your breast looks or feels firmer than usual, especially to the touch

If your breasts feel harder than usual to the touch, it may be a sign of capsular contracture. Capsular contracture is when scar tissue forms around an implant, causing it to harden and potentially stick out from the skin. The symptoms are often painful and uncomfortable, though some women also experience distortion of their breast shape.

Hardening of the implant

When implants harden, it’s called capsular contracture. This is a normal process that happens after breast augmentation surgery. However, if you experience any of the following symptoms it may be an infection:

• A firm lump under your breast skin
• Pain in your breast
• Swelling, redness or warmth around your incision site

Capsular contracture can also be caused by trauma to the breast area, such as an injury or accident.

Firmness or hardness that doesn’t seem to be going away

Firmness or hardness that doesn’t seem to be going away can be a sign of capsular contracture. But it could also indicate other problems, including an infection or other conditions.

If you experience pain and swelling, or if your breasts become hard for no reason, visit your doctor right away; these symptoms could indicate that something serious is happening inside your chest cavity.

Distortion of the shape of your breast

Breast augmentation is a surgical procedure that improves the size, shape and appearance of your breasts. Breast implants are placed behind your breast tissue to make them larger or to add volume. There are two types of implants: saline and silicone. Silicone implants are more natural-looking than saline ones, but they may rupture over time. Both types of breast implants can be inserted under the muscle or over it and in different sizes depending on what you want to achieve with your surgery.

Tenderness and pain in your breast

It is normal to experience breast tenderness after a breast augmentation. This can occur in one or both breasts, and the pain may be mild or severe. The pain can be felt in the breast itself, under the armpit or even in the shoulder blade area. Breast augmentation capsular contracture symptoms may also include pain when lying down and wearing tight clothing.

Hardening of implants and changes in shape can be signs of something wrong.

Capsular contracture is a condition that causes your breast implants to become hard and painful. It can also cause the size of your breasts to change. This can make it difficult to wear certain clothes or feel comfortable with yourself.

If you have capsular contracture, you’ll need surgery to remove scar tissue from around the implant so it will be softer again. After surgery, most people get better, but for some people, capsular contracture gets worse again after treatment or doesn’t go away completely.

is capsular contracture dangerous

Capsular contracture is a tightening (“contracture”) of the scar tissue that forms around the breast implant after it is placed (the “capsule”). Mild contractures can feel firm. More severe contractures can be painful and may distort the breast by pulling the breast implant up significantly.

The rate of contracture varies greatly in medical studies and I have seen reported numbers from 10 as high as 50%. We do not know for certain what causes capsular contracture, but we now have some pretty good ideas.

If a patient has significant bleeding around the implant at the time of or shortly after surgery (a hematoma) and it is not removed, then the old blood can stimulate a tightening of the scar tissue capsule and cause a contracture. In a patient having a followup or “secondary” surgery, a drain is frequently used for a few days. I have found that drains are generally not needed in a patient having surgery for the first time. But we ask patients to avoid medications and supplements for two weeks before surgery that might increase the risk of bleeding, such as fish oil, extra vitamin E, Aspirin, Ibuprofen, etc. Your doctor should give you a list, and call to check if you are not sure. I have also found it to be helpful in my practice to avoid blunt dissection or “tearing” of the space for the implant and instead do a careful electrocautery dissection of the space.

But the more and more studies are suggesting that the main cause of capsular contracture is “Biofilm”. If bacteria gets on the implant it can “wall itself off” with a protective barrier that prevents the body from fighting it and getting rid of it. Tartar on the teeth that the dentist removes for you twice a year is one example of a Biofilm. Although the patient may not get a true infection, the body is fighting the biofilm, and the scar tissue is stimulated to harden. When patients have implants removed and immediately replaced for capsular contracture, the subsequent risk of repeat contracture is as high as 70%!. This now makes sense, because as long as a speck of bacteria is still in the old space, the biofilm and contracture can recur. And studies have shown that even when bacteria can not be cultured from a breast capsule contracture, that special assays can still detect bacteria. So prevention is key. Newly released long term studies of breast implant complications has shown a higher incidence of capsular contracture when the implant is placed through the axilla (armpit) or around the nipple, as compared to the inframammary (breast fold) incision. We know that nipple ducts harbor bacteria. So one way to decrease the risk of a contracture is to use the inframammary fold incision. I now place a temporary plastic patch over the nipple during surgery to shield the surgical field from this potential source of bacteria. I irrigate the pocket where the implant is going to be placed with a triple antibiotic mixture that has been shown to decrease the risk of capsular contracture, and is left in the pocket with the implant to be absorbed.1 This study reduced the rate of clinically significant capsular contracture (grade III/IV) to 1.8 % at 6 years in breast augmentation patients. In addition I will change our surgical gloves just before implant placement and place a temporary plastic barrier over the skin so that the implant does not touch the skin as it is being placed.

Finally, we have patients with breast implants to consider whether or not to take a single dose of oral antibiotics before dental procedures to decrease the risk of bacterial entering from the mouth through breaks in the gums and traveling through the bloodstream to the implants. There is some controversy regarding the benefit of dental prophylaxis for patients with breast implants and not all plastic surgeons agree. But this is commonly recommended for patients that have a heart valve because of the risk, so I discuss the pros and cons with patients and let them decide.

The above comments/procedures are my personal experience and practice and are representative of where I have personally evolved over the years in my practice. . And with these methods I have seen a similar reduction in clinically significant capsular contracture in my patients to mirror the study below.

Other surgeons may have other methods that work for them in their practices. You should expect some discussion with your surgeon as to methods that he/she uses to reduce the incidence of capsular contracture.

does capsular contracture get worse

Sometimes, no matter how skilled a patient’s plastic surgeon is, complications arise during or after surgery. This is the case because everyone’s body is different. The composition of connective tissue varies widely from one patient to another, for instance, and this means that each patient’s healing process is entirely unique. This is why some people tend to develop thick scar tissue after any kind of penetrating skin injury, while others can sustain deep cuts and develop only subtle scarring that fades over time. Another good example of this difference is the way some women will develop severe stretch marks during pregnancy no matter what they do to prevent them, whereas other women emerge from pregnancy nearly stretch mark-free. Additionally, everyone’s immune system responds differently to stimuli, and some patients’ immune systems react poorly to medical implants.

Of course, complications during plastic surgery are now very rare, both because of advances in surgical techniques and because we’ve gotten better at predicting which patients are likely to experience surgical complications. Patients who are prone to developing thick scar tissue may be advised to avoid having plastic surgery, or their surgeon will use special surgical techniques that allow incisions to be placed remotely (e.g., inserting breast implants through an incision in the underarm) in order to keep scarring largely out of sight. Patients who have compromised immune systems or autoimmune diseases are often advised to forego surgery and choose less invasive forms of cosmetic enhancement. Likewise, there are a number of procedures that can be used after surgery, such as the Aspen Rehabilitation Technique, in order to treat complications and improve the patient’s appearance. One of the most common areas where Aspen is used is in the treatment of capsular contracture after breast augmentation surgery.

What is capsular contracture?

The formation of a “capsule” of scar tissue around any kind of implant (medical or cosmetic) is a normal part of the healing process. The body automatically reacts to any foreign object it detects within it and attempts to isolate said object by creating a barrier of scar tissue around it. In the case of breast implants, this is usually a good thing – the capsule helps to keep the breast implants in place, preventing slippage. In some patients, however, this capsule of scar tissue becomes unusually hard and starts to contract around the implant. This can lead to both aesthetic problems and, in extreme cases, pain in the breasts. Research shows that about one in six breast augmentation patients experience some degree of capsular contracture, though not all cases present with obvious symptoms. The severity of capsular contracture is rated using a grading system:

Generally, capsular contracture occurs during the healing process. About 75% of all capsular contractures will occur within two years of the patient’s implants being placed. Sometimes capsular contractures occur many years after breast augmentation surgery, but this is the exception rather than the rule. If this does occur, the patient’s breast implants should be checked for ruptures. Ruptured implants are the most common cause of late-onset capsular contraction.

What causes capsular contracture?

Clinicians have a number of theories on what causes capsular contracture, and it’s likely that the exact causes of this condition vary from patient to patient. As a breast augmentation patient, it’s important to understand that this condition is not caused by breast implants being in any way toxic or dangerous. Saline implants contain only saline solution, which can be safely reabsorbed by the body with no ill effects, and silicone gel implants are made of medically inert silicone. Indeed, capsular contracture can happen after any kind of medical implant is inserted into the body; the condition is not unique to breast augmentation surgery. Capsular contracture is just particularly troubling when it occurs after breast augmentation because it often alters the appearance of the breasts, thereby jeopardizing the aesthetic improvements that the patient had surgery to create. Capsular contracture is not usually dangerous to the patient’s health unless her implants have ruptured (in the case of gel implants, rupture can sometimes lead to infection).

Researchers believe genetics play a role in who develops capsular contraction and who does not. If you have a family history of autoimmune disease or you have relatives who frequently develop thick scar tissue after injury (or who have had difficulties with medical implants), then you may have a slightly heightened risk of developing this condition. However, it’s impossible to accurately predict who will develop a “random” case of capsular contracture (i.e., one that is not caused by any identifiable external factors) and who will not. Because capsular contracture is highly treatable, you shouldn’t let a fear of developing this condition hold you back from getting breast augmentation surgery.

Sometimes, capsular contracture is caused by something other than the patient’s own body reacting poorly to the presence of breast implants. In addition to implant ruptures, it is now believed that something called “biofilm” often leads to the development of this condition. Biofilm is a thin layer of bacteria that develops around implants after a type of bacteria (often staph bacteria) is introduced to the breast cavity during surgery. This bacterium causes a kind of chronic, low-grade infection that may not produce noticeable symptoms (such as fever or severe fatigue). However, as the body combats this infection, it produces more and more fibrous scar tissue, eventually leading to capsular contracture. The biofilm theory of capsular contracture was given credence by a recent study conducted on pigs who were implanted with medical-grade silicone implants. This study showed that there was a significant increase in the likelihood of capsular contracture in those pigs who had staph bacteria on their skin at the time of implant placement. It’s important to note that staph contamination during breast augmentation surgery does not necessarily result from an unhygienic working environment. Some people are natural carriers of staph bacteria; it’s always present on their skin and usually causes no symptoms. Only when these individuals have their skin penetrated does this bacterium have a chance to cause any serious issues. While ensuring a clean working environment can certainly help to lower the risk of staph contamination, it’s not always possible to eliminate 100% of the bacteria that are present.

Other rare complications of breast augmentation surgery, such as hematomas and seromas (blood clots that sometimes form after invasive surgery), are also believed to increase the risk of capsular contracture. Some researchers believe these blood clots increase the likelihood of capsular contracture by providing a rich supply of nutrients (in the form of blood) for bacteria, thereby encouraging the growth of biofilm. How can capsular contracture be prevented?

While it’s impossible to prevent capsular contracture from occurring in every patient, there are several ways to lower a patient’s risk of developing this condition. To that end, plastic surgeons now employ a number of different preventative strategies, as outlined below:

How does Aspen treat and reverse capsular contracture?

In the past, the treatment options available for breast augmentation patients with capsular contracture left much to be desired. Revision surgery was often required—a lengthy, costly and uncomfortable solution. During this process, the patient’s implants were removed, she was treated with antibiotics and eventually (once the infection had subsided), she could choose to have breast implants inserted again. However, because this surgical approach makes the body vulnerable to a second bacterial invasion, many of these patients experienced repeated incidences of capsular contracture.

Aspen multi-energy therapy is different. It’s completely noninvasive, so it doesn’t cause the patient pain or inconvenience, nor does it increase her risk of developing capsular contracture again in the future. During Aspen therapy, a special device (the Aspen harmonizer) is applied to the patient’s breast tissue, without any incisions being made. The Aspen harmonizer delivers precisely controlled ultrasound waves to the patient’s tissue, encouraging the growth of healthy collagen. This increases elasticity within the breast capsule around the implant, making the breasts feel soft and pliable again. Furthermore, the ultrasound waves used during Aspen therapy have been shown to increase the effectiveness of antibiotics in combating biofilm. Aspen therapy is usually administered over two to three weeks in combination with antibiotic therapy to target the root cause of capsular contracture. The Aspen method has been shown to be effective for grade two and grade three cases of capsular contracture. Grade four cases may require more aggressive surgical intervention.

If you’re a good candidate for Aspen therapy, this pain-free procedure can treat and reverse capsular contracture. Contact a board-certified plastic surgeon to learn more about this procedure.

how to break up scar tissue around breast implants

After breast cancer surgery, many women opt for breast implants. There are pros and cons of breast implants–both physical and psychological. The most common physical risk, occurring in about 10% of cases, is scarring called “capsular contracture.”

What is Capsular Contracture?

The body forms fibrous scar tissue around any foreign object in its tissues. This “bubble” of scar tissue is called the “capsule” and–normally–is relatively thin and soft. In the case of breast reconstruction, the capsule is beneficial, as it keeps the implant in place. In some instances, though, the capsule thickens, hardens, and contracts. The results can be tightness, pain, and visible distortion of the implant.

The precise causes of capsulitis are not certain, but one review of studies found that “Risk factors … included the use of smooth (vs. textured) implants, a subglandular (vs. submuscular) placement, use of a silicone (vs. saline) filled implant and previous radiotherapy to the breast” (PubMed). Infection at the surgery site can also contribute to this excessive scarring.

There are corrective surgery options for capsular contracture, but physical therapy can also be effective to reduce the pain and tightness.

Conditions Similar to Capsular Contracture

The shoulder area is intricate, and damage to it can create undesirable symptoms which are nuanced depending on the precise cause and location of the trauma.

Other conditions that are similar to capsular contracture include adhesive capsulitis, radiation fibrosis, and cording. These conditions are all technically distinct, but they have similar causes, symptoms, and treatments.

The following table breaks it down.

Swipe left on mobile to view the whole table.

While there are treatments for each of these conditions, the best ways to avoid these problems are regular physical therapy under the supervision of an expert and a diet that minimizes inflammation.

Preventing Scar Tissue

We can all agree that prevention is better than treatment, and that are methods to prevent the scar tissue from forming in the first place:

The results from a number of studies of non-surgical approaches basically demonstrate that it is best to take a multi-pronged approach and not rely on one single method. And start early.

Treatments for Capsular Contracture

Surgery

Corrective surgical options involve entirely removing both the capsule and implant (perhaps installing a new implant, perhaps not), cutting open the capsule without disturbing the implant, or full breast reconstruction. Surgery may be a standard method to treat capsular contracture, and surgery may be the only viable option in severe cases of capsular contracture, but obviously avoiding it is preferable!

Closed Capsulotomy

One non-surgical option is “closed capsulotomy”–essentially, applying a lot of pressure to break up the scar capsule. The contracture may or may not recur–it’s about 50/50. Implant manufacturers advise against this (due to the risk of rupturing the implant), but several studies consider it a worthwhile option, especially since complications are rare.

Physical Therapy

If scarring or tightness is already occurring, regenerative healing requires the right building blocks (nutrients), and also the right conditions. Physical therapy helps provide the right conditions for your body to rebuild.

Self-massage is recognized as beneficial therapy for preventing or treating capsular contracture, and your physician may recommend it (after initial healing has taken place). However, working with an experienced oncology physical therapist is also recommended since she can perform techniques you cannot, evaluate your progress more objectively, and precisely advise you on what methods would be most effective at each stage in the healing process.

If possible, set an initial “baseline” appointment with a PT prior to any surgery or radiation for breast cancer. Then follow up with your therapist as soon as possible during or after treatment. Early intervention can prevent many forms of scarring, toughening, and tightening (as well as lymphedema and related conditions). This can entirely eliminate the need for invasive revision surgeries or the riskier non-invasive methods later on

If you are experiencing symptoms of capsular contracture or just hope to avoid it entirely, please schedule a free 15-minute consultation with us to discuss your situation.