CAPSULAR CONTRACTURE OF THE BREAST
What is it?
Capsular Contracture is a condition that may affect those who undergo breast augmentation, either electively or after breast reconstruction. It is a hardening and constriction of the breast implant capsule and causes breast firmness. In the most severe cases, it can create a painful, distorted, misshaped, or oddly positioned implant.
The truth is that a capsule is natural, and forms around any foreign object in our bodies, in this case, the breast implant. This “capsule” or implant shell is similar to the thin opaque membrane that one may see when you break open a hardboiled egg. It’s the flimsy/ rubbery covering inside the shell but outside covering of the egg.
A capsule normally occurs to anything “foreign” inside the body, like hip replacement prosthesis, metal fragments, or even a thorn deeply lodged inside the body. It becomes a problem, when the natural capsule is triggered to constrict or fibrose, which ultimately causes hardening of the breast implant shell and possibly other problems.
Causes of Capsular Contracture:
The origin of Capsular Contracture is speculated to be from a number of causes that are still up for review. The following are generally well accepted as possible causes:
- Bacterial Infection
- Hematoma (Excessive blood that collects in an area)
- Seroma (Non-blood type watery liquid that collects in an area)
- Radiation treatment for breast cancer
Signs of capsular contracture:
Capsular Contracture firmness is graded using the Baker Grading System:
- Grade I: Breast looks and feels normal
- Grade II: Breast feels a little firm but looks normal
- Grade III: Breast is more firm and is visually distorted (shape change or mal-positioned)
- Grade IV: Breast is hard and greatly distorted in shape and position
- IMPLANT NOT DROPPING OR IN HIGH POSITION
- DISTORTED SHAPE OR APPEARANCE
TYPES OF SURGICAL PROCEDURES may help prevent capsular contracture. Some recommend that certain types of implants or placement of the implant may reduce contracture. The fact is that even the “perfect” surgery under the best conditions can result in a breast implant encapsulation.
MASSAGING and/or wearing a compression garment/ bandage may help reduce the incidence of contracture with the goal of not allowing the fibrous capsule to reach a state of excessive hardness. The Aspen Multi-Energy System ™, a Post-Plastic Surgery Technology, specializes in addressing this type of issues.
Despite the best efforts, capsular contracture may happen. The American Society of Plastic Surgeons (ASPS) conducted a study on how often capsular contracture occurs depending on type of procedure (above or below muscle implant placement) and the type of implant (silicone or saline). On average, 9-33% of women may encounter a breast encapsulation sometime in their life after breast implant surgery. Women who undergo breast reconstruction after Cancer, who have radiation treatment, tend to be on the higher end of the statistics.
CAPSULE SURGERY, often known as open capsulectomy or capsulotomy, can be done to release, cut, and allow for opening of the contracture. The goal is to release the tightness and allow for return of softness. An alternate method is called a closed capsulotomy. This is where the surgeon physically breaks the capsule forcibly by squeezing the breast from the outside to allow for release and softening. This method is not widely used as it is painful, voids the implant warranty, may create instability in the position of the implant, and may compromise the implant itself. For years surgery has been the only effective option, however the re-occurrence rate for contracture is much higher than anyone would like. The Aspen Multi-Energy System ™ is designed and tailored to give the surgeon a better option.
The Aspen Harmonizer ™ in conjunction with The Aspen Breast Therapy and an antibiotic therapy regiment is used as a prophylactic to help prevent capsular contracture by increasing the circulation to the area that can assist the antibiotic to penetrate the biofilm layer.