A breast should be soft, flexible, and drape naturally, even if it is a reconstructed breast that was surgically created after a mastectomy. There are many options for breast reconstruction, the most popular being breast implants. Capsular contracture is a common complication of breast implant surgery, occurring in women who choose saline or silicone implants. This problem can cause your reconstructed breast to shift, change shape, or feel quite hard. If this happens in your case, you can get treatment for capsular contracture to correct the problem.
Understanding Capsular Contracture
Your body is smart -- your immune system knows when a foreign object has been put within your tissues. When an intruder (such as a breast implant) is detected, a periprosthetic capsule is formed around it. Think of it this way: Your chest muscles and skin don't readily accept an implant as a natural part of your breast. In order to isolate the implant and keep it from growing, spreading, or wandering around, your body creates a sac, or capsule of scar tissue around it, to seal it off. A capsule around a breast implant is a naturally occurring tissue that can benefit you. However, if that capsule contracts or thickens, it can squeeze your implant. This contracture is what will cause pain, shifting, distortion, and hardening of the reconstructed breast.
Possible Causes of The Squeeze
Capsular contracture can happen around any type of breast implant. It occurs more often around silicone, rather than saline implants. Sometimes it develops due to an infection that sneaks in during implant surgery. But other problems may also crop up, like a seroma (a pocket of blood serum within the surgical area) or a hematoma (a pool of blood below the skin). These may also contribute to the development of capsular contracture.
Giving The Problem a Grade
Capsular contracture is graded by the Baker scale and follows this criteria:
- Grade I - the breast is soft and appears normal, and the capsule is flexible.
- Grade II - the breast looks normal, but is somewhat hard to the touch.
- Grade III - the breast is hard, has some distortion caused by contracture, or the breast becomes a rounded shape, or the implant is generally tilted upwards.
- Grade IV - similar to grade III but with greater hardening of the capsule.
Preventing Capsular Contracture
You and your surgeon can work together to prevent the development of a stiff capsule of tissue around your breast implant. Your surgeon may prescribe preoperative medications such as prednisone and vitamin E, so be sure to take these as directed. Implants can be located beneath the mammary gland or within a muscle pocket -- those that are placed within muscle are less apt to develop capsular contracture. Your surgeon may use Alloderm to line the muscle pocket to further reduce the likelihood of scar tissue build-up around your implant.
If you have surgical drains to maintain after breast surgery, be sure to empty these on schedule -- this helps prevent seromas from developing. Finally, your surgeon may suggest that you do post-operative massage on the reconstructed breast and do arm exercises to keep the area supple and soft.
Boost Your Recovery From Breast Surgery
Here are a few things to avoid after breast implant surgery that will ensure a healthy recovery:
- Quit smoking before surgery if you can, and don't smoke during your recovery period. Using tobacco products will delay healing and recovery from surgery.
- Take it easy doing physical activities and avoid injury or impact to the newly reconstructed breast. The implant needs time to settle into place, so don't jostle, squeeze, or strike the surgical site at all.
- If you know that you'll be having chest wall radiation after your mastectomy, consider delaying implant surgery until treatments are completed. Radiation can stiffen affected tissues and cause capsular contracture, so waiting is well worth your time.
Treatments for Capsular Contracture
If you do develop stiff tissue around a breast implant, if the shape distorts, or if the implant wanders out of position, you can get help. A capsulectomy is surgery that removes the stiffened capsule, and the implant may be replaced during this procedure for best results.
A capsulotomy is surgery to loosen the scar tissue by slicing it, which allows for expansion.
Surgery may not always be needed, however -- there are other methods that use massage, ultrasound, and medications to make the stiff capsule relax. Talk to your doctor about your options.
Incidence of capsular contracture in silicone versus saline cosmetic augmentation mammoplasty: A meta-analysis. Yasser El-Sheikh, MD, Roberto Tutino, MD, Casey Knight, MD, Farough Farrokhyar, PhD, and Nicolas Hynes, MSc MD FRCSC. Can J Plast Surg. 2008 Winter; 16(4): 211-215.
Immediate Breast Tissue Expander-Implant Reconstruction With Inferolateral AlloDerm Hammock and Postoperative Radiation: A Preliminary Report. Karl H. Breuing, MD and Amy S. Colwell, MD. Eplasty. 2009; 9: e16. Published online 2009 May 15.