Capsular contracture is a common complication that can occur after breast augmentation or reconstruction surgery. It refers to tightening or hardening of the capsule of scar tissue that naturally forms around breast implants. Capsular contracture can range from mild firmness and discomfort to severe pain, distortion, and hardness of the breast. While the condition tends to progress gradually in most cases, some people do experience a more sudden onset of significant capsular contracture.
What is capsular contracture?
After a woman gets breast implants, her body forms a lining of scar tissue called a capsule around the implant. This is a normal response. In capsular contracture, the scar tissue tightens and squeezes the implant. This can make the breast feel firm or hard and can cause pain and changes in the shape of the breast.
Capsular contracture is classified into four grades based on severity:
- Grade I – the breast is normally soft and looks normal
- 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 very abnormal
Higher grades indicate more severe tightening and squeezing of the implant by the surrounding scar tissue capsule. Lower grades are more subtle and involve mild firmness.
What causes capsular contracture?
The exact causes of capsular contracture are not fully understood. However, some factors that are thought to increase the risk include:
- Bacterial contamination – Bacteria introduced at the time of surgery or through hematoma/seroma can trigger inflammation and scarring.
- Subglandular placement – Placing the implant behind the breast tissue but on top of the chest muscle increases risk compared to submuscular placement.
- Textured implants – Textured implant surfaces seem to carry a higher risk than smooth implants.
- Radiation therapy – Prior radiation to the breast for cancer treatment increases risk.
- Hematoma/seroma – Blood or fluid collecting around the implant can increase inflammation.
Essentially, anything that causes inflammation in the breast and around the implant may activate fibroblasts, cells that generate scar tissue. This leads to capsular contracture.
Does capsular contracture come on suddenly?
In most cases, the development of capsular contracture is gradual. Many patients experience slowly increasing firmness and fullness in the breast over weeks to months. The condition often continues progressing very slowly over years.
However, some individuals do report a fairly rapid onset of significant capsular contracture symptoms, over just a few days or weeks. There are a few reasons why this sudden worsening may occur:
- Acute injury or infection – Trauma to the breast, like a blow or injury during sports, can cause sudden inflammation and scar tissue formation. An acute infection in the breast for any reason could also rapidly accelerate capsular contracture.
- Hematoma/seroma – Bleeding or fluid buildup around the implant can appear quickly after surgery and cause swift capsular contracture if not promptly addressed.
- Progression of existing low-grade contracture – Sometimes mild capsular contracture that has developed slowly over time can seem to suddenly get more severe. In reality, it has likely been present for a while and only now passed the threshold for noticeable symptoms.
For women who are predisposed to capsular contracture, a triggering event like the above could lead to a relatively rapid transition from a mild form to a more significant degree of contracture over days or weeks. However, coming on completely “out of the blue” with no preceding signs is less common.
What does sudden onset capsular contracture feel like?
When capsular contracture comes on quickly, women may notice the following new or rapidly worsening symptoms:
- Firmness and fullness of the breast
- A “tight”, taut sensation
- Pain or tenderness, especially when pressing on the breast
- Change in breast shape – the breast may appear rounded or distorted
- A raised or rippled appearance of the skin overlying the implant
- Asymmetrical or uneven appearance between breasts
Typically both breasts are affected, but one side may display more severe contracture. The rapidity of symptom onset is the distinguishing feature when capsular contracture comes on suddenly. Similar sensations that develop slowly over weeks or months tend to reflect more typical gradual progression.
Is sudden capsular contracture an emergency?
Sudden onset of significant capsular contracture may feel concerning, but it does not usually constitute a medical emergency. However, there are some important considerations for acute management:
- Seek prompt medical evaluation – Rapid changes warrant imaging and exam to determine if bleeding or infection are factors driving the process.
- Review pain control options – Severe pain may require prescriptions or procedures for relief until the contracture can be surgically addressed.
- Discuss timing of corrective surgery – Quick progression often leads doctors to recommend sooner rather than later surgery to resolve the contracture before it gets worse.
- Address emotional impact – Sudden distortion in breast appearance can be distressing. Counseling and support resources help women cope.
Though not an emergency, sudden contracture should be managed actively for the best results. Monitoring for signs of new infection is also important.
Can sudden capsular contracture resolve on its own?
It is very unlikely for significant, rapid onset capsular contracture to improve spontaneously without intervention. Some potential exceptions include:
- Mild grade I/II contracture – Slight firmness or fullness may sometimes resolve in a few weeks with anti-inflammatory medications if due to trauma or minor infection.
- After pregnancy/breastfeeding – Hormone changes and increased blood flow may soften slight contracture that developed during pregnancy or after nursing a baby.
- Early hematoma/seroma absorption – If caught very quickly, draining fluid buildup before it stimulates extensive scarring can reverse associated contracture.
However, most cases of clinically significant contracture require surgery like implant removal with or without capsulectomy for definitive correction. Leaving moderate or severe contracture expecting spontaneous improvement typically leads to disappointment.
Can physical therapy help capsular contracture?
Some doctors recommend breast massage techniques after augmentation or reconstruction surgery to help prevent capsular contracture. However, once significant contracture develops, physical therapy has very limited utility in reversing it.
Gentle massage and pressure techniques may provide some relief from pain and stiffness associated with contracture. But the manipulations do not break up the thick, dense scar tissue causing the implant squeezing. There is no high quality evidence showing lasting improvement in the contracture itself with physical therapy.
When should capsular contracture be treated surgically?
| Grade of Contracture | Appropriate Surgical Treatment Timing |
|---|---|
| Grade I (breast soft) | No surgery needed unless progressively worsening |
| Grade II (breast firm but normal appearing) | Consider surgery if symptoms unacceptable or getting worse |
| Grade III (breast firm and distorted) | Surgery usually appropriate due to abnormal appearance |
| Grade IV (breast very hard/painful) | Prompt surgery recommended for severe symptoms |
As this table illustrates, higher grades of capsular contracture typically warrant surgical intervention for both cosmetic and symptom relief purposes. Milder grades may be observed if not bothersome.
Sudden onset capsular contracture, regardless of grade, generally prompts earlier surgical correction. This aims to halt progression and address the underlying inflammatory process before it causes additional scar tissue burden.
What are the surgical options for capsular contracture treatment?
The main surgical approaches to treat significant capsular contracture include:
- Total capsulectomy – Removing the entire scar tissue capsule around the implant, often with implant replacement.
- Breast implant removal (explant) – Removing the implant without capsule excision. May do alone or with replacement.
- Capsulotomy – Cutting or releasing some of the capsule without total removal.
Total capsulectomy is the most involved but thorough technique. It provides the best chance of permanently resolving contracture. Implant explant or exchange alone has high recurrence rates if any capsule remains.
Discussion between the patient and surgeon guides surgical planning. Outcomes are best when the right approach is selected for each individual scenario.
| Surgical Procedure | Considerations |
|---|---|
| Total Capsulectomy |
|
| Breast Implant Removal |
|
| Capsulotomy |
|
What is the recovery like after surgical treatment?
Recovery differs depending on the type of surgery performed for capsular contracture:
- Capsulectomy – Significant postoperative pain is common after total capsulectomy. Drainage tubes are often placed to prevent fluid buildup. Arm movement may be restricted for several weeks, with no strenuous activity for 6-8 weeks. Full recovery takes 3-6 months.
- Implant removal – Less pain than capsulectomy but discomfort, tightness, and swelling still occur. Drains may be used. Sutures are removed within 1-2 weeks. Can generally return to non-strenuous activity in 2-4 weeks.
- Capsulotomy – Milder pain and a faster recovery of 1-2 weeks with minimal activity restrictions since the breast remains intact.
Pain medication and close follow-up are important parts of the recovery process after surgical treatment of capsular contracture. Complication rates are higher with more complex procedures.
How can capsular contracture be prevented?
Full prevention of capsular contracture is difficult, since scarring and tightening can occur even with ideal implant placement and surgical technique. However, surgeons can utilize strategies to reduce the risk of contracture developing:
- Using only sterile equipment and meticulous sterile technique during surgery
- Thorough irrigation with antibiotics before implant placement
- Avoiding bleeding, hematoma, and fluid accumulation around the implant
- Placing implants under rather than over chest muscle (submuscular)
- Using smooth rather than textured implant outer shells
- Avoiding radiation therapy to the breast after augmentation
Post-surgery, patients play a role in prevention by:
- Keeping incisions clean and watching for signs of infection
- Following activity restrictions during recovery to avoid trauma
- Massaging the breast as directed to maintain pocket integrity
- Attending regular follow-up visits for early contracture detection
Even with best efforts at prevention, some degree of capsular contracture occurs in 10-20% of breast augmentation patients over 10 years.
What is the prognosis for capsular contracture treatment?
The prognosis following surgical treatment of capsular contracture depends on several factors:
- Grade/severity – More severe grades have higher recurrence rates.
- Cause – Contracture driven by infection complicates the prognosis.
- Surgical approach – Total capsulectomy offers the best prognosis for permanent resolution.
- Implant placement – Submuscular has lower recurrence than subglandular.
- Implant shell – Smooth shells have lower contracture rates than textured.
With appropriate surgical techniques like total capsulectomy and wise implant selection, about 70-80% of cases have good long-term outcomes after contracture surgery. However, some degree of recurrence is always a possibility with breast implants.
Conclusion
While capsular contracture most often develops slowly over months to years, sudden onset does sometimes occur. Quick worsening is often prompted by trauma, infection, or progression of unnoticed mild contracture. Though alarming, rapid contracture is not usually an emergency. Prompt surgical correction provides the best results, with techniques tailored to each patient’s unique case. Prevention aims to avoid triggers like contamination and minimize inflammation around implants. Overall, careful planning and management is key to addressing this common breast implant complication.