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Capsular Contracture after Breast Augmentation and Change of Implants

Capsular contracture is the most common complication after breast augmentation, up to 10% and the most common reason for further surgery. Unfortunately it is not possible to predict who will have this problem or when it will occur.

The human body forms a layer of scar tissue around any implanted material and this happens also with breast implants. Usually this layer is quite thin and soft but in some people it can become thick and hard, making the breast feel and look unnatural. When this occurs it is called a capsular contracture.

When capsular contracture is present the breasts may become hard, change in shape or even be painful. Occasionally the problems may improve with some anti-inflammatory medication but often an operation is required. This involves cutting through the capsule and around the edge, to release the tightness and increase the breast pocket. When there is a thick capsule with calcium deposits it is necessary to remove part or even all the capsule. In very thin women this can make the edges of the implant visible underneath the skin.

Capsulectomy is a very thorough procedure and does carry a high risk of bleeding postoperatively. The operation may require a new incision to be made. When the breast implant has been placed in a pocket under the breast tissue only (subglandular), the chance of capsule recurring can be further reduced by moving it to a deeper position underneath the chest muscle (submuscular).

If the implant that is in place is damaged or old, it will be replaced with a new modern implant. The breast implants that we use have a textured surface which research has shown is less likely to cause capsule formation than the smooth breast implant types.

These procedures are carried out under general anaesthesia and may require an overnight stay in hospital. It can be painful afterwards, particularly if the implant has been moved under the muscle. Drains are left in the breast pocket overnight and removed the following day.

Sutures are removed 7 - 10 days postoperatively. Swelling may last for several weeks and if surgery has been necessary on one side only, this will cause temporary asymmetry as a result of swelling.

The potential complications of these procedures are similar to those that may occur after the initial breast augmentation. Postoperative bleeding is a particular risk after surgery for capsular contracture. The old implant may be damaged during the surgery, as it is not designed for removal and reinsertion; this is something that may not be apparent at the time of surgery, but could potentially lead to rupture of the implant at a later time.

Infection is uncommon, but antibiotics are given to minimise the chances of this occurring. In some cases the previous incision can be used, but for capsulectomy it is often necessary to make a new incision. Some people form bad scars, red lumpy scars my need treatment with steroid injections or silicone sheet. Keloid scars may be difficult to treat with any form of treatment.

Capsular contracture often does not affect both breasts to the same degree and some degree of breast asymmetry may persist after the operation. Replacing the implant in a new pocket will alter the shape of the breast.

If the breast implant settles too high or low, it may need to be repositioned by another operation. Placement of the implant under the chest muscle may reduce the strength of those muscles and affect the exercise performance. Loss of nipple sensation occurs in less than 5% of patients having a breast augmentation and there is a small risk of a similar problem occurring after treatment of capsule. Occasionally, sensation can be temporarily increased. Whether the change in sensation will be permanent will not be known for at least one year postoperatively.

Despite all the precautions taken to minimise the chance of capsular contracture recurring, it may not be possible to prevent it from happening again. The only way to be certain of not developing a further capsule is to have the breast implants removed and not replaced.