Capsular contracture involves the hardening of the fibrous tissue that surrounds all breast implants after implanted in the body, for example during breast augmentation surgery or breast reconstruction. It is quite rare, and something most patients will never experience. It can occur in the tissue surrounding one or both implants. Capsular contracture varies in its severity, and the most severe type can be painful. Myofibroblast cells, which make up a component of the capsule, the same cells that cause wounds to contract as they heal, will also contract to varying degrees inside your body.
There are four grades of capsular contracture, known as Baker Grades:
Grade I: Breast is normally soft and looks natural
Grade II: Breast is a little firm but looks normal
Grade III: Breast is firm and looks abnormal
Grade IV: Breast is hard, painful, and looks abnormal
Grades III and IV capsular contracture are considered severe, and may require reoperation or implant removal. Capsular contracture, whether mild, moderate or severe, may occur more than once in the same implant.
The incidence of capsular contracture is quite low: between 4%, as estimated by Ideal Implants in their FDA Patient Labeling, and 8%, as estimated by Mentor in its FDA Patient Labeling, primary breast augmentation patients.
We aren’t sure why capsular contracture occurs, but there is some thought in the scientific community that it is correlated to bacterial contamination during the initial breast implant insertion. This postulated bacterium is normal skin flora and lives in the milk ducts. As a board-certified plastic surgeon, Dr. Zuckerman is very familiar with the latest protocols to minimize this risk. For example, during the procedure, Dr. Zuckerman irrigates the breast pocket where the implants will be placed three times with triple antibiotic solution. He then repreps and redrapes the entire sterile surgical field and changes his gloves prior to insertion of the implants. In addition, to place the breast implants, he uses an implant delivery device called a Keller funnel, which allows him to insert the implants without ever touching them.