Capsular Contracture After Breast Reconstruction: What Can Be Done?

Breast reconstruction is a significant procedure for women following a mastectomy. It restores the breast to a normal shape and can greatly change how one feels about their body. But as with any operation, there are risks. One of the issues that may occur as a result of breast reconstruction is called breast reconstruction capsular contracture.

Today, we will describe what capsular contracture is, why it occurs, and above all, what can be done about it.

What is Capsular Contracture?

When you have breast implants, your body automatically creates a layer of scar tissue that surrounds them. It’s normal. It’s how your body protects itself from anything it perceives as "foreign." They call this a capsule.
Yet occasionally, that capsule becomes too tight or too thick. If this occurs, it may squeeze the implant, leading to discomfort, pain, or a change in breast appearance. We call it capsular contracture after breast reconstruction.
It may make your breast hard, look lopsided, or sit higher than the other breast. Occasionally, it may even hurt.

What Causes Breast Reconstruction Implant Capsular Contracture?

Physicians are still not 100 percent certain why breast reconstruction capsular contracture occurs in some women and not others. Here are a few potential risk factors:

• Infection after surgery
• Bleeding or Fluid Accumulation Surrounding the Implant
• Use of radiation therapy in cancer therapy
• Development of seroma (fluid collection) postoperatively
• A history of autoimmune disease

It also occurs more frequently in silicone implants compared to saline, although both may be implicated.

Signs You Might Have Capsular Contracture

Capsular contracture after breast reconstruction does not always occur immediately. It may occur weeks, months, or years following breast reconstruction.
These are some typical signs to watch for:

• The breast is hard or tight
• There is discomfort or pain, particularly upon touching the breast
• The breast appears higher or uneven
• You see a change in size or form

Physicians tend to classify the severity of the contracture using a system known as the Baker Scale, ranging from Grade I (normal) to Grade IV (severe pain and firm, distorted breast).

What Can You Do About Breast Reconstruction Capsular Contracture?

The better news is that you can get it treated. What you need to do depends on how severe it is.

1. Mild Cases (Grade I or II)

If your implant still feels natural and you are not in any pain, your doctor may recommend watchful waiting. It means checking it frequently but not hurrying to any treatments.
In certain instances, drugs such as Singulair (for asthma) or Accolate were used off-label to reduce inflammation and soften the capsule, although varying results can be expected.

1. Grade III or IV: Moderate to Severe Cases

If the breast hurts or is otherwise distorted, then surgery may be the ideal course of action. These are typical procedures:

• Capsulectomy: The surgeon excises the dense capsule and may replace the implant.
• Capsulotomy: Cutting the capsule to relieve tightening, but it is not taken away.
• Changing Implant Location: Replacing the implant in a new location (e.g., from above the muscle to below the muscle) may reduce recurrence risk.

Does Breast Reconstruction Implant Capsular Contracture Cause Pain?

There is no method of definitely avoiding breast reconstruction implant capsular contracture, but there are a few steps that might minimally reduce the risk:

• Select a board-certified plastic surgeon who specializes in breast reconstruction
• Follow all post-operative care instructions
• Inquire of your surgeon whether textured implants may reduce the risk in your situation
• Discuss any medical or prior infections with your surgeon prior to surgery
• If you had radiation therapy, discuss additional reconstructive options such as flap surgery, which is implant-free and might carry a lower risk of contracture.

Conclusion

Capsular contracture after breast reconstruction is frustrating, particularly after experiencing something as emotional as breast reconstruction. But you are not alone—and there are options.
If you experience any change in your reconstructed breast, contact your plastic surgeon immediately. The sooner it gets examined, the simpler it is to deal with. And always keep in mind that your comfort, health, and well-being come first.