Breast implant contracture, also known as capsular contracture, is a common complication occurring after breast augmentation surgery. This condition refers to the abnormal tightening and hardening of the scar tissue (capsule) around the breast implant, leading to discomfort, distortion, and potentially affecting the aesthetic outcome of the procedure. In this article, we will explore breast implant contracture from both the patient's and the plastic surgeon's perspective, highlighting its causes, symptoms, treatment options, and preventive measures.
Causes
The precise cause of breast implant contracture is still not fully understood. However, several factors have been identified as potential contributors to the development of this condition:
1. Bacterial contamination:
In some cases, bacterial contamination during surgery or postoperative infections may trigger an inflammatory response, leading to excessive scar tissue formation and subsequent contracture.
2. Implant rupture or leakage:
Implant rupture or leakage can result in the release of silicone or saline solution into the surrounding tissues, causing inflammation and capsular contracture over time.
3. Hematoma:
The presence of a hematoma (collection of blood) around the implant can induce inflammation and promote the formation of abnormal scar tissue.
4. Suboptimal implant placement:
If the implant is not correctly positioned during surgery or if the pocket created for the implant is too small, it can lead to a higher risk of contracture in the long term.
5. Autoimmune response:
There is evidence to suggest that some individuals may have a genetic predisposition to an exaggerated immune response, leading to an increased risk of developing breast implant contracture.
Symptoms
Breast implant contracture can manifest in various ways, with symptoms ranging from mild to severe. The most common symptoms include:
1. Firmness or hardening of the breast:
One of the earliest signs of contracture is the development of firmness or hardness in the breast, often on one side only.
2. Discomfort or pain:
Patients may experience discomfort or even mild pain in the affected breast, especially when pressure is applied.
3. Visible distortion:
Contracture can cause the breast to appear distorted, asymmetrical, or unusually positioned compared to the unaffected breast.
4. Breast shape changes:
The affected breast may undergo changes in shape, becoming more rounded, elevated, or constricted, giving it an unnatural appearance.
5. Implant palpability:
In severe cases, the implant may become easily palpable due to the tightened scar tissue surrounding it.
Treatment Options
When diagnosed with breast implant contracture, patients should consult with a qualified plastic surgeon to determine the most appropriate treatment plan. Some commonly employed treatment options include:
1. Capsulotomy:
A capsulotomy involves surgically releasing or partially removing the scar tissue capsule, allowing for better implant movement and reducing the firmness or hardness of the breast.
2. Capsulectomy:
A capsulectomy involves complete removal of the scar tissue capsule. This is typically performed for more severe cases of contracture and may require implant replacement.
3. Implant exchange:
In cases where the implant is compromised due to rupture or leakage, an implant exchange procedure may be necessary. This involves removing the faulty implant and replacing it with a new one.
4. Implant pocket change:
Changing the implant pocket position can help reduce the risk of recurrent contracture. For instance, switching from the subglandular to the submuscular position or vice versa may be considered.
Preventive Measures
While breast implant contracture cannot always be completely prevented, certain measures can help reduce the risk. These include:
1. Choosing a qualified surgeon:
Select a board-certified plastic surgeon with extensive experience in breast augmentation surgery to ensure proper technique and minimize the risk of complications.
2. Antibiotic prophylaxis:
Administering antibiotics before and after the surgery can help reduce the risk of infection, which is a potential contributing factor to contracture.
3. Proper implant selection:
Working closely with your surgeon to select an appropriate implant size, shape, and material that best suits your body type and individual goals can help optimize the outcome and minimize complications.
4. Regular follow-ups:
Attend scheduled follow-up visits with your surgeon to assess the health of your implants and detect any early signs of contracture.
Conclusion
Breast implant contracture is a complex condition with multiple contributing factors. Early recognition of symptoms and prompt consultation with a plastic surgeon are crucial for appropriate management. By understanding the causes, recognizing the symptoms, exploring available treatments, and following preventive measures, individuals considering or having undergone breast augmentation can make informed decisions and minimize the risk of contracture.
References:
1. Adams WP Jr, Culbertson EJ, Deva AK, et al. Macrotextured breast implants with defined steps to minimize implant-related complications using the BREAST-Q. Plast Reconstr Surg. 2017;140(3):427e-436e. doi:10.1097/PRS.0000000000003558
2. Wong CH, Samuel M, Tan BK, Song C. Capsular contracture in subglandular breast augmentation with textured versus smooth breast implants: a systematic review. Plast Reconstr Surg. 2006;118(5):1224-1236. doi:10.1097/01.prs.0000234057.05273.96
3. Wong CH, Samuel M, Tan BK, Song C. Capsular contracture after breast augmentation: an imaging and histologic analysis of treatment and prevention. Plast Reconstr Surg. 2010;126(1):214-221. doi:10.1097/PRS.0b013e3181da8697
