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Breast Implant Illness

What is Capsular Contracture?

Breast implants have become increasingly common, driven by the desire for enhanced physical aesthetics. However, they carry significant potential complications, including capsular contracture, which can cause discomfort, distortion, and the need for further surgery. This article aims to shed light on what capsular contracture is, its causes, its impact, and the importance of considering these risks before opting for breast implants.

About Capsular Contracture

When a foreign object, such as a breast implant, is introduced into the body, the body’s natural response is to isolate it by forming a capsule of fibrous tissue. Capsular contracture occurs when this capsule tightens and squeezes the implant. This contraction can cause various symptoms, from mild firmness and shape distortion to severe pain and visible deformity. The degree of severity is classified into four stages or grades.

Stages of Capsular Contracture

Grade I
In the first grade of capsular contracture, the breast is soft and looks natural, much like an unoperated breast. The capsule that forms around the implant is thin and pliable, allowing the implant to move freely. This stage isn’t considered a case of contracture, as it is the body’s normal response to the presence of a foreign object. Patients in this stage won’t experience any discomfort, and the implants retain their intended aesthetic appearance.
Grade II
In Grade II, the breast is somewhat firm but doesn’t show visible distortion and generally doesn’t cause discomfort. Though the breast may not feel as natural as in Grade I, it still maintains a normal appearance. The capsule around the implant has started to tighten at this stage, but not to a significant extent. It is generally not a stage that requires treatment unless the firmness is of concern to the patient or there’s an anticipation of progression.
Grade III
In Grade III, the breast becomes noticeably firm and may begin to look abnormal due to the significant constriction of the capsule around the implant. This can lead to a change in the shape of the breast, with the implant often appearing too high on the chest or the breast looking round or ball-like. At this stage, patients may also experience discomfort due to the tightening capsule. In most cases, surgical intervention is required to alleviate symptoms.
Grade IV
Grade IV is the most severe form of capsular contracture. The breast is hard and often painful to touch. The excessive contraction of the capsule causes visible distortion and deformity of the breast, which can be quite significant and noticeable even under clothing. This stage can cause substantial discomfort and negatively impact the patient’s quality of life. Treatment at this stage almost always requires surgery, which may involve removing the hardened capsule and implant.

Signs & Symptoms of Capsular Contracture:

  • Breast firmness
  • Breast shape distortion
  • Breast pain
  • Visible asymmetry
  • Palpable hardening
  • Positional changes of the breast and/or nipple
  • Unusual roundness of the breast
  • Breast height looking unnaturally high
  • Tightness or pressure in the breast area
  • Breast discomfort during physical activities

What Causes Capsular Contracture?

The precise cause of capsular contracture remains unclear to the medical community. It’s believed to be a complex interplay of various factors. One possible factor is a bacterial infection around the implant. Microscopic contamination during surgery can lead to biofilm formation, potentially instigating capsular contracture.

Another significant risk factor is an implant rupture. If an implant breaks, it may irritate the surrounding tissue, prompting the formation of a tighter capsule. Similarly, a hematoma or seroma, that is, collections of blood or fluid around the implant, can also provoke an inflammatory response, leading to contracture.

Furthermore, some researchers believe that an excessive inflammatory response by the body itself can contribute to capsular contracture. As part of its defense mechanism, the body naturally forms a fibrous capsule around the implant. If this immune response is overly aggressive, it may result in an overly tight capsule, leading to contracture.

The Impact on Patient’s Health and Lifestyle

Capsular contracture can have significant implications for a patient’s health and lifestyle. Besides physical discomfort and altered physical appearance, it can affect a woman’s self-esteem and emotional well-being. The requirement for further surgery not only imposes additional financial burdens but also brings potential risks associated with surgical procedures.

Implant Removal to Prevent Capsular Contracture

Breast implant removal, particularly through en-bloc capsulectomy, offers an effective solution to prevent capsular contracture and other implant-associated risks like BII (breast implant illness) and breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). In this procedure, the implant and the entire surrounding capsule are removed intact, eliminating any foreign material in the body. This prevents further complications and the risk of capsular contracture.

Before choosing breast implants, it is crucial to be fully informed about the potential complications, including capsular contracture. These complications can significantly impact your health and lifestyle, necessitate further surgeries, and lead to unplanned financial costs. While breast implants might promise an improved body image, many women have found that the true cost of that aesthetic outcome is far too great.

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