Capsular contracture, how to detect it? – MAPFRE Blogs

Capsular contracture is a rare complication of breast prostheses. Learn about its causes, diagnosis and treatment options to alleviate it.

Capsular contracture is one of the best-known complications – although rare – in breast prosthesis wearers. To understand what it involves, it is useful to first know how breast augmentation surgery was developed, how the implants are placed and what happens in the body after the intervention.

Brief historical context

The first aesthetic surgery for breast augmentation with the placement of a prosthesis was performed in the United States in 1962. Its use spread throughout Europe in the 1970s and became popular in Spain between the 1980s and 1990s, reaching its peak in the 2000s. Since then, it has remained stable with about 18,000 to 20,000 interventions per year. At the moment, approximately 2% of the Spanish female population wears breast prosthesesplacing the country among those with the highest percentage of carriers: behind Italy, but ahead of several countries in northern Europe.

What is breast augmentation?

The intervention consists of placing a rounded medical device under the breast to replace it, increase it or rebuild its volume. Over time, materials and techniques have evolved, and today silicone-encased prostheses are used that have different characteristics.

Types of prostheses according to their content

• Silicone (cohesive gel): more natural to the touch.
• Physiological serum: lighter saline solution.

Types of prostheses according to the external surface

Types of prostheses according to their shape

• Round: They provide greater fullness in the upper part.
• Anatomical or drop-shaped: imitate the natural shape of the breast.

Types of implant placement

• Subglandular: below the mammary gland and above the muscle.
• Submuscular: below the pectoral muscle.

The choice depends on the characteristics of each woman. The surgeon, based on his experience and individual analysis, will guide towards the most appropriate option.

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How is the surgery performed?

Regardless of the type of prosthesis, the intervention involves making an incision in the most convenient area, always ensuring that the scar is as little visible as possible. It can be located:

• At the limit of the areola.
• In the undermammary fold, or in the armpit.

Through this incision, a space or “pocket” is created, located above or below the pectoral muscle and behind the mammary gland, where the prosthesis is placed.

The capsule: a normal reaction of the body

After surgery, the body recognizes the prosthesis as a foreign element (not dangerous) and mild, localized inflammation occurs. The tissues heal by forming a layer of fibrous tissue called capsule, a physiological reaction that acts as a protective barrier.

In the vast majority of cases, this capsule is thin, flexible and beneficial as it stabilizes the implant. It is important to highlight that every prosthesis develops its capsule, and this is not pathological.

What is capsular contracture?

In some cases, for various reasons, the capsule may become much thicker, fibrous and rigid. As it contracts around the prosthesis, internal pressure increases and the implant acquires a more spherical shape. This is when capsular contracture appears.

This complication can be unilateral or bilateral and is classified into four degrees of severity according to Baker’s classification. Its manifestations include:

• Pain and discomfort.
• Aesthetic changes, such as alteration of the shape or position of the implant.
• Progressive hardening, which can become stony in extreme cases.
• In the most severe degrees, the contracture can favor the breakage of the prosthesis and the escape of its contents outside the envelope.

Causes of capsular contracture

The causes can be diverse:

• Diffusion of silicone particles from the envelope or interior of the prosthesis, triggering an exaggerated reaction to a foreign body.
• Infections.
• Post-surgical hematomas or seromas, which increase inflammation.
• Immunological factors.

The contracture can appear early, between 4 and 8 months after implantationalthough it can also occur late, even years later.

Incidence

Its approximate incidence is:

• 2-3% in textured implants placed in a submuscular position.
• Up to 10% on smooth implants placed in a subglandular position.

Treatment

When the contracture is mild and does not generate symptoms, clinical follow-up and massages may be chosen.

In the most severe cases, surgery is required to remove the abnormal capsule and/or change the implant. Even so, the possibility of recurrence exists.

What you should know…

• Capsular contracture is a known but rare complication in women who wear breast prostheses.
• Advances in materials and surgical techniques have significantly reduced its incidence, allowing the majority of patients to enjoy safe, stable and long-lasting results.
• When the contracture is mild and does not generate symptoms, clinical follow-up and massages may be chosen.