Breast augmentation surgery is one of the in-demand cosmetic procedures. Women who have breast issues see it as a go-to solution.
The surgery is suitable for small breasts, asymmetrical breasts, and breast deformities. It provides the best enhancement to achieve bigger beautiful, young-looking breasts.
Sadly, undesirable outcomes are inevitable. It results in distress to both the patient and the surgeon. It is such an impediment that nobody wants. Nevertheless, there are different ways to reduce the risk of its occurrence.
The most common breast implant complication is capsular contracture. Let’s better understand it as a breast deformity, its causes, and the best solutions.
Capsular Contracture
Capsular contracture is a condition when your body forms tight fibrous bands around the breast implant. In turn, it pulls on your breast tissue, causing deformity and pain.
Naturally, our body reacts to any foreign object placed inside. Our immune system works automatically by isolating it, producing a tough scar tissue (fibrous capsule) to surround it. It is part of the healing process.
According to the best plastic surgeon in Columbus Ohio, most women who have breast augmentation surgery have a thin capsule. It is around 1mm and does not interfere with the breast’s final shape.
Nonetheless, not all are lucky. Some women experience an exaggerated immunologic response. As a result, the fibrous capsule is thicker and harder. Thus, pulling your breast tissue together leading to adverse outcomes.
Capsular contracture has several grades of severity (Baker Classification). The worst form causes your breast to become firm, hard, deformed, unnaturally round, and painful.
Causes of Capsular Contracture
Around 8% to 15% of women who had breast augmentation surgery experience capsular contracture. Despite the prevalence, doctors still can’t completely understand why such complications happen. Nevertheless, researchers have a couple of theories of its occurrence.
Exaggerated Immunologic Response
The normal healing process involves creating a fibrous capsule. It consists of collagen, myofibrils, and other cells. Then, it surrounds and isolates the implant. The entire process does not affect the shape of the breast.
Some unlucky women develop a more excessive immune response. The immune cells stimulate the further formation of the capsule.
Adverse Inflammatory Reaction
Studies show that bacterial contamination of the implant causes such complications. A subsequent inflammatory reaction is behind the thick fibrous capsule formation.
Naturally, your skin and nipple contain many bacteria. When these come in contact with the implant, it contaminates them.
Most operations use strict sterile techniques and apply triple-antibiotic breast irrigation. Despite the preventive contamination measures, such conditions still occur.
Risk Factors
Capsular contracture happens due to the following risk factors.
Surgery Reason
The reason for breast enhancement plays an important role. The first-time boob job has a low risk compared to implant revision.
Breast Cancer Treatment
The risk is higher for those receiving chemotherapy or radiotherapy.
Brand of Breast Implant
Brands, types, and models of implants play an essential role. As of now, there is no specific brand that incurs the higher risk. Discuss a reputable brand with your plastic surgeon.
Implant Filling
Implant filling has two types. Both fillings have pros and cons related to capsular contracture.
Silicone Filling gives a more natural look and feel.
Saline Filling more comfortable to place and adjust.
Surgical Technique
An implant placed under the chest muscle (submuscular) carries a lower risk of forming capsular contracture.
Surgeons use sterile techniques and antibiotic wash in the surgical area to lower bacterial contamination and contracture formation.
Time
The longer the implant is in your body, the more likely is the capsular contracture development.
Symptoms of Capsular Contracture
Symptoms are usually progressive, and the severity increases in time.
Pain
It occurs when the capsule of the affected breast becomes too tight.
Changes in Breast Shape
The affected breast shrinks and gains a heterogenous contour. It looks more spherical with unnatural curvature.
Change in Breast Consistency
The breast becomes firmer, harder, and inconsistent since the implant is thicker.
Feeling
The implant location becomes displaced. Sometimes in the armpit area.
Diagnostic Tests for Capsular Contracture
Visit your doctor if you suspect a capsular contracture. Surgeons confirm it through interviews and physical examinations. Diagnostic procedures provide a full assessment.
MRI Scanning
It is considered the gold standard for diagnosing capsular contracture.
Mammography
It is useful in detecting mild and moderate capsular contracture but has limitations in severe cases.
Ultrasound
It detects the complication but in a subjective manner. It is more or less based on the doctor’s experience.
Baker Classification System
Surgeons determine the capsular contracture severity.
Baker I: Breasts look and feel natural. No treatment is necessary.
Baker II: Minimal contracture. With little firmness but no other symptoms. No treatment is necessary.
Baker III: Moderate contracture. Abnormally firm with some degree of deformity. It needs immediate treatment.
Baker IV: Severe Contracture. The breast looks deformed, feels hard and painful. It needs immediate treatment.
Once the doctor identifies the Baker grade, deciding the possible treatment option is next.
Treatments for Capsular Contracture
Plastic surgeons depend on the treatment on severity. It can be surgical and non-surgical.
Non-surgical Treatment
Here are alternative treatments to break the scar tissue.
Closed Capsulotomy. The surgeon manually manipulates the breast by pulling and pushing it in different directions. It loosens the fibrous bands that cause capsular contracture. However, it poses a high risk of implant rupture and hematoma.
Ultrasound Therapy. The sound waves relax the breast’s tight scar tissue but need multiple sessions.
Topical Vitamin E. Applying a prescribed cream is said to soften the scar tissue.
Injectables. Triamcinolone and Botulinum toxin A (Botox) can make the capsule thinner and softer.
Oral Medications. Pirfenidone, Montelukast, and Zafirlukast have anti-inflammatory properties. It helps get rid of capsular contracture without surgery.
These non-surgical treatments are still under investigation. Further research is necessary before they become standard practice.
Surgical Treatment
Revision surgery is the most effective treatment for severe capsular contractures.
Capsulotomy. A less extensive surgical revision procedure. The tight bands pulling your breast together are cut. Therefore, releasing your breast to become softer without removing the capsule. It is preferable if the implants are submuscular.
Capsulectomy. The surgeon cuts out and removes all the fibrous tissue around the implant. An invasive procedure and poses higher risks like hematoma formation and pneumothorax.
Implant re-placement. Repositions the implant to reduce the risk of recurrence. It further improves outcomes after capsulotomy or capsulectomy.
Implant removal. Advisable for severe cases with multiple recurrences. However, the cosmetic results are usually undesirable – unappealing excess skin. SGAP breast reconstruction is necessary afterward.
Tips to Prevent Capsular Contracture
Prevent capsular contracture before surgery begins.
Implant of Choice
Choose a reputable brand of implant that guarantees minimal risks. Textured implants are a better option.
Plastic Surgeon
Pick licensed and experienced surgeons. They follow strict sterile techniques to reduce contamination. Also, choose those who conduct follow-up long after surgery.
Breast Massage
Massage the breast daily to stimulate the blood flow around the implant. Do this for the first few months after surgery.
Breast augmentation surgery is not only for cosmetic reasons. If deemed to undergo this procedure, beware of its complications. Take note of the symptoms and necessary treatments. Most importantly, apply the preventive tips to avoid capsular contracture.
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