Posted: April 17, 2012
Capsular contracture, commonly referred to as CC is the condition where the scar tissue that forms around breast implants in all cases, normally thin and soft, becomes thick and firm. The incidence of having some form of this is probably close to 15% but accurate statistics are hard to come by. This can become so severe that the breast becomes misshapen, distorted and even painful in some cases. One of the first signs of a woman developing this is a firm feeling to the breast that seems different than the other side. It can also be seen as changing shape or size, commonly looking a little bit higher at the top. We think there may be a variety of factors that may contribute to this condition, such as bleeding, implant rupture, too large of an implant, or possibly immobility, but now there seems to also be the idea that there may be micro-contaminants on the surface of the implant that cause a tissue reaction.
Most often what I have seen in my practice is that if a woman is going to develop this, she usually does so in the first 6 months. That is not to say that she cannot develop this later on, but the chances seem less.
My first non-surgical course of action if a woman begins to feel a change is to begin vigorous massage and in many cases this early tightness can be reversed. Medications have been tried but the data is unclear or non-existent as to its effect.
Should the condition progress, the first surgical option is Capsulotomy, where the capsule is opened and multiple cuts are made in order to open the space that holds the implant. The next step is more aggressive. It is called Capsulectomy and instead of cuts being made in the capsule, it is entirely removed. Different implants may be tried and changing the location of the implant to above or below the muscle may help as well. Other options may be to place a tissue “spacer” into the wall of the capsule that is more resistant to contracture. I prefer to use Strattice Acellular Dermal Matrix for this and the success rate seems to be very high.
Having said all of this, there are some women that will continue to have hardening of the capsule no matter what is done and it may only be on one side as well. More needs to be done to fully understand this process that fortunately only happens in the minority of cases.