Capsular contracture

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Editors-In-Chief: Martin I. Newman, M.D., FACS, Cleveland Clinic Florida, [1]; Michel C. Samson, M.D., FRCSC, FACS [2]


Overview

Grade IV capsular contracture in the right breast of a 29-year-old woman seven years after subglandular placement of 560cc silicone gel-filled breast implants

Capsular contracture is an abnormal response of the immune system to foreign biomaterials and alloplastic materials. It is most discussed in the context of complications from breast implants and artificial joint prosthetics.

Capsules of tightly-woven collagen fibers normally form as an immune response around a foreign body (eg. breast implants, pacemakers, orthopedic joint prosthetics), tending to wall it off. Capsular contracture occurs when the capsule tightens and squeezes the implant. This contracture is a complication that can be very painful and distort the appearance of the implanted breast or limit the range of motion of a artificial joint. The exact cause of contracture is not known. However, some factors include bacterial contamination, silicone breast implant rupture or leakage, and hematoma. Capsular contracture may happen again after additional surgery.

Methods which have reduced capsular contracture include submuscular breast implant placement, using textured[1][2] or polyurethane-coated implants,[3] limiting handling of the implants and skin contact prior to insertion[4] and irrigation with triple-antibiotic solutions.[5]

Correction of capsular contracture may require surgical removal or release of the capsule, or removal and possible replacement of the implant itself. Closed capsulotomy (disrupting the capsule via external manipulation), a once common maneuver for treating hard capsules, has been discouraged as it can cause implant rupture. Nonsurgical methods of treating capsules include massage, external ultrasound,[6] treatment with leukotriene pathway inhibitors (Accolate, Singulair),[7] [8]and pulsed electromagnetic field therapy.[9]

There are four grades of breast capsular contracture - Baker grades I through IV. The Baker grading is as follows:

  • Grade I the breast is normally soft and looks natural
  • Grade II the breast is a little firm but looks normal
  • Grade III the breast is firm and looks abnormal
  • Grade IV the breast is hard, painful, and looks abnormal.

Sources

References

  1. Barnsley GP (2006). "Textured surface breast implants in the prevention of capsular contracture among breast augmentation patients: a meta-analysis of randomized controlled trials". Plast Reconstr Surg. 117 (7): 2182–90. PMID 16772915.
  2. Wong CH, Samuel M, Tan BK, Song C. (2006). "Capsular contracture in subglandular breast augmentation with textured versus smooth breast implants: a systematic review". Plast Reconstr Surg. 118 (5): 1224–36. PMID 17016195.
  3. Handel N; et al. (2006). "Long-term safety and efficacy of polyurethane foam-covered breast implants". Aesth. Surg Journal. 26 (3): 265–74. Unknown parameter |month= ignored (help)
  4. Mladick RA (1993). ""No-touch" submuscular saline breast augmentation technique". Aesth. Surg Journal. 17 (3): 183–92. PMID 8213311.
  5. Adams WP jr.; et al. (2006). "Enhancing patient outcomes in aesthetic and reconstructive breast surgery using triple antibiotic breast irrigation: six-year prospective clinical study". Plast Reconstr Surg. 117 (1): 30–36. PMID 16404244.
  6. Planas J (2001). "Five-year experience on ultrasonic treatment of breast contractures". Aesthetic Plast Surg. 25 (2): 89–93. PMID 11349308.
  7. Schlesinger SL, wt al (2002). "Zafirlukast (Accolate): A new treatment for capsular contracture". Aesthetic Plast Surg. 22 (4): 329–336.
  8. Scuderi N; et al. (2006). "The effects of zafirlukast on capsular contracture: preliminary report". Aesthetic Plast Surg. 30 (5): 513–20. PMID 16977359.
  9. Silver H (1982). "Reduction of capsular contracture with two-stage augmentation mammaplasty and pulsed electromagnetic energy (Diapulse therapy)". Plast Reconstr Surg. 69 (5): 802–8. PMID 7071225.

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