A breast implant capsule is the firm, sometimes hard and thick, scar tissue that forms on the inside of the breasts and surrounds the breast implants after breast enlargement surgery. This sphere can contract over time, and squeeze the breast implants (capsular contracture). This would certainly place the breast implants in one position with almost no mobility. The positions of the left and right implants may be distorted with respect to each other, and also in relation to the chest wall. The shape of the breasts may also be made abnormal in any direction. The breasts may also feel unnaturally hard. Finally, significant pain may also be present. The incidence of capsular contracture is thought by many plastic surgeons to be related to blood collection, fluid collection, contamination, or infection at the time of breast enlargement surgery. It is also more common when the breast implants are placed on top rather than behind the pectoralis muscle, and in revision-augmentation. Capsular contracture after breast augmentation is also a risk factor for implant rupture owing to the squeezing of the breast implant by the capsule. This capsular contracture is the most common overall reason for re-operation in breast augmentation patients. It is assigned various grades of severity as noted below, with grades 3 and 4 generally requiring re-operation.
- Baker Grade I: the breast is normally soft and looks natural
- Baker Grade II: the breast is a little firm but looks normal
- Baker Grade III: the breast is firm and looks abnormal
- Baker Grade IV: the breast is hard, painful, and looks abnormal
Surgical options for the treatment of capsular contracture include releasing the capsule circumferentially, completely excising the capsule, or even the former or latter combined with breast implant replacement. Regardless of the intervention, there is no guarantee against the recurrence of capsular contracture.
The Mentor Core Study put the risk of capsular contracture at 8% for the first 3 years after operation for primary augmentation patients. In revision-augmentation the risk was much higher at 19% over the first 3 years.
The Allergan Core Study put the risk of capsular contracture at 13% for the first 4 years after operation for primary augmentation patients. In revision-augmentation the risk was much higher at 17% over the first 4 years.