Breast augmentation
Capsular contraction is one of the most dreaded issues in breast augmentation. While it was a common occurrence in the past, it rarely happens today, thanks to more refined surgical techniques and prosthetic devices designed specifically to counteract this phenomenon.
What if the form? How if it is clear?
Once a breast implant is placed, the body organizes itself to isolate it by generating a thin tissue layer that surrounds it (peri-prosthetic capsule). When the peri-prosthetic capsule thickens, the implant becomes more palpable, and the breast becomes firm.
Capsular contraction is classified into four grades (Becker’s classification) based on the degree of contraction, the hardness of the implant, and pain. The thicker the capsule, the firmer it becomes. In higher grades, the implant, held tightly by the capsule, is deformed by it, causing the breast to lose its natural and original shape. Additionally, since capsular contraction is rarely symmetrical, the shape of the two breasts becomes different.
Capsular contraction typically occurs shortly after implantation, but it is not uncommon for it to occur even years later.
What causes a "normal" periprosthetic capsule to thicken and transform into a contracted capsule?
Scientific studies and the latest research agree in considering hyperreactivity of the capsule to have certain and uncertain causes. The certain causes include individual predisposition, low-quality implants, and postoperative issues (hematomas, seromas, and postoperative infections that stimulate capsule formation). Among the uncertain causes, the theory of microinfection should be mentioned. According to this theory, prosthetic reactivity is attributed to the presence of bacteria in the capsule with characteristics insufficient to cause clinically detectable infections but sufficient to hyperstimulate the capsule.
Is breast augmentation safe today?
Surgical techniques have evolved over the years; conscientious surgeons know how important accurate and precise methods are to reduce capsule stimulation. It is also crucial to choose a modern and high-quality implant. Implants produced in recent years have very different characteristics compared to those of the past; they are designed to combat the phenomenon of capsular contracture from the outset. This does not mean that capsular contracture is now just a memory of the past, but it signifies that the likelihood of developing this issue is significantly lower.
What to do?
There are no universally recognized guidelines for addressing this issue. However, common sense and surgical experience provide the following indications:
Mild contracture, mild hardness: Frequent and vigorous massage is often able to treat and maintain the contracture in the initial phase.
Moderate contracture: Vigorous massage (squeezing) is still considered by some as a valid technique to break the periprosthetic capsule, while others consider it a technique to abandon because it adds further stimulus to the capsule. The literature is not unanimous. Common sense suggests that if the contracture is not significant, squeezing can be attempted. If the contracture is more severe, then capsulotomy (a surgical procedure to open the capsule) should be considered, and possibly replacing the implants.
High-grade contracture: Capsulectomy (removal of the capsule) and implant replacement, possibly changing the plane (e.g., from subglandular to submuscular), are key elements of the treatment. In more severe cases, the use of polyurethane implants (silicone implants coated with a thin polyurethane membrane), a material that significantly opposes periprosthetic capsule formation, can be beneficial.
There are also additional treatments, proposed by some authors as adjuncts in the fight against contracture, but their scientific validity has never been demonstrated, such as the administration of bronchodilators and the use of ultrasound.
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