Capsular fibrosis (so-called capsular contracture) is one of the most widespread complications after breast augmentation with implants. This is formation of capsules around the implant that may lead to its deformation and contractions.
Formation of capsules is natural reaction of the immune system to foreign objects. The capsule that forms during wound regeneration fixed the implant, and its structure reminds of the mammary gland. However, in case of capsular fibrosis, this capsule is very solid, and it pushes against the implant. As the result, it gets hard, deforms and causes pain.
Capsular fibrosis can occur any time after operation, and may affect one or both mammary gland.
Pretty often, women after breast surgery are embarrassed when they feel pain and unpleasant sensations in breast, or notice sudden changes. Can it be an early sign of capsular fibrosis? Sometimes women can complain because of the sensation of loading on breast: it may happen during the first year after operation, being caused by inflammatory reactions. Are there any symptoms of capsular fibrosis in this case?
Capsular fibrosis has a few pronounced symptoms experiencing which a woman should immediately visit a surgeon. Only the doctor can define whether there’s incapsulation of implant that should be quickly eliminated. When the following symptoms appear in one or both breasts, the chance of having capsular fibrosis are pretty high:
- Serious pain and sensation of tightness in chest;
- breast deformation or changes of implant form;
- movement or deformation of the implants;
- a solid capsule inside the breasts;
- breast asymmetry and formation of wrinkles and folds.
According to four-grade Baker scale, capsular fibrosis has four stages, they are also called “Baker’s stages”. Depending on the severity of disease, it can be either minor hardening (I stage by Baker), or formation of pronounced capsules with visible deformation (IV stage by Baker).
- Stage I – normal state: the breast is soft at touch, it has natural appearance, visible or sensible chages are absent.
- Stage II – minor capsular contracture: minimal hardening of breast accompanied by absence of visual changes.
- Stage III – serious capsular contracture: breast hardening with visible deformation, but there’s no pain.
- Stage IV – pronounced capsular fibrosis: sensible breast hardening accompanied by severe pain and serious deformation.
One method of capsular contracture treatment is so-called endoscopic capsulotomy. When there’s deformation taking place because of scars, capsular tissue is cut so that the implant could get more space.
Innovative ultrasound methods of capsular fibrosis treatment imply working directly with connective tissues. Ultrasound generator has effect on breast tissues and stimulates supply with blood and oxygen. This way, the contracture dissolves. When minor capsular contracture is treated, the disease can be successfully eliminated with a few sessions.
Capsular contraction of stages III and IV is accompanies with pronounced symptoms, and spoils breast appearance significantly. Such contractures can be typically eliminated with the help of a secondary operation. During such surgery, the capsule and the implant are totally removed to install a new implant.
Unfortunately, capsular contracture cannot be totally avoided in some cases, even if the risks are minimized when the factors promoting contracture are excluded.
During the last years, the frequency of capsular contraction has decreased considerably, because innovative structural implants are being introduced. Different researches have proved that use of texturized implants (with uneven surface) reduces the chance of capsular contracture in comparison with smooth implants. Today, experts often argue trying to decide whether the structure of implant has any meaning, though it’s supposed that it can have real connection with the risk of developing capsular fibrosis. Therefore, it’s recommended to use texturized implants.
Clinical data also shows that the location of implant is another factor promoting development of capsular fibrosis. It’s clear that there’s certain connection between the location of the implant and stage of disease by Baker. Therefore, the risk of developing capsular fibrosis when the implant lies under muscles (submuscular location) is lower than when the implant is placed above breast muscles (retroglandular location). It doesn’t mean though that submuscular implant location is always the best solution. It’s the surgeon who decides how to place the implant basing on patient’s overall health: the variant should be beneficial from both aesthetic and medical standpoints.
While location and structure of the implant are regarded as the factors connected with development of capsular fibrosis, there are some preventative measures for this disease. Modern units emit ultrasound waves that improve blood circulation and ensure oxygen supply of breast tissues: it helps to reduce the risk of developing capsular contracture. It is proved by numerous specialists of plastic and aesthetic surgery who have already implemented ultrasound treatment in their treatment. In a best-case scenario, a couple of preventative ultrasound sessions are enough to prevent development of capsular contracture.
Besides, regular massage helps to lower the risk of capsular fibrosis.