The capsule is a lining that the body creates around a breast prosthesis. This process is completely normal, but occasionally, the lining that the body creates thickens and squeezes the implant, which is known as capsular contracture.
When we place an implant, whether it is a breast, hip or knee prosthesis, the body creates a lining around it. In breast augmentation or breast reconstruction this process is called “capsular contracture”. It is a completely normal phenomenon that occurs in all patients and with all types of prostheses, as it is the body’s natural reaction to a foreign body.
In normal situations, this layer is very thin, but in some women, this capsule tends to thicken and squeeze the implant. The reasons are not yet known, but this process is known as capsular contracture and is classified into four degrees:
1. In the first degree, the breast is soft and the result is natural. All women who wear prostheses have at least this degree, since in all of them a capsule is formed.
2. In grade two the breast is a little firm but still looks natural, as there is minimal capsular contracture that does not even require treatment.
3. During a third degree, the breast is firm and the shape looks somewhat distorted, as the implant is being squeezed, usually upward and is taking a round shape.
4. In grade four capsular contracture the appearance of grade three is accompanied by discomfort and pain due to progressive hardening of the capsule.
Although the causes of capsular contracture are unclear, there are some factors that seem to be related to a higher risk, such as bacterial contamination of the implant shell, infections, seromas and hematomas due to an inflammatory reaction of the organism. The use of smooth prosthesis or placed above the pectoral muscle, that is to say, in subglandular position also has higher risks of capsular contracture.
Risks
First of all, it is important to know that it is not the prosthesis that becomes hard, since if we take it out, we notice that it is as soft as when it was placed, but it is the capsule that is created around it that hardens. The prosthesis is an inert material.
Secondly, capsular contracture alone cannot break the prosthesis, because the pressure is exerted uniformly on it. On the other hand, it also does not increase the risk of breast cancer because it does not affect the mammary gland.
In addition, only a small percentage of women who wear prostheses develop a grade three or four capsular contracture, the only cases in which surgery is needed.
If it is needed, it will be performed as in the previous operation and all or part of the capsule will be removed and the implant will be replaced by a new one. If it has been placed in subglandular position, it is advisable to change it to subpectoral. In short, it is a matter of starting from scratch the formation of a capsule and it is very rare for patients to develop capsular contracture again after this second procedure.