Any time that a breast implant is implanted into a person, the body responds by forming a fibrous capsule around it. The fibrous capsule is the body's natural way of walling off what it sees as a potential source of infection. In most cases, this capsule does not cause any problems and simply remains around the breast implant. However, in some cases, the fibrous capsule becomes thickened and contracts. The condition in which this occurs is called capsular contracture.
MRI of breast implant capsular contractureTo the right is an MRI of a patient with Grade IV capsular contracture. Note the multiple foldings and deformities around the breast implants, which is characteristic of capsular contracture. Breast implants should be smooth and round, not folded and deformed!
Capsular Contracture Baker Grading ScaleThe severity of breast implant capsular contracture is determined by the Baker Grading Scale. There are four levels of capsular contracture:
Baker Grade I capsular contracture: Breast implant is soft, but appears natural
Baker Grade II capsular contracture: Breast implant is firm, but appears natural
Baker Grade III capsular contracture: Breast implant is firm, and appears distorted
Baker Grade IV capsular contracture: Breast implant is firm, appears distorted, and is painful
What causes capsular contracture?
Nobody knows for sure what causes capsular contracture. Certain surgical factors, such as placing the implant below the pectorals muscle and using textured implants seem to be associated with lower capsular contracture rate. Recently, research has shown that the presence of bacteria in the breast implant pocket may contribute to the development of capsular contracture. In order to reduce bacterial contamination during breast implant insertion, Los Angeles plastic surgeon Dr. Elliot Hirsch uses "minimal touch technique," in which the breast implant package is opened, antibiotic irrigation is poured over the implant, Dr. Hirsch changes his gloves, the skin surrounding the incision is re-sterilized, and then the implant is inserted with minimal contact with the skin. Dr. Hirsch also uses the Keller funnel, which is another device that minimizes breast implant contact with the skin.
How is breast implant capsular contracture treated?
Dr. Hirsch uses a variety of techniques to treat breast implant capsular contracture. Occasionally, he will use a capsulotomy or capsulectomy in combination with a breast implant plane change from below the breast gland to below the muscle. This has the effect of giving the breast a smoother, more natural shape. Also, Dr. Hirsch will occasionally use a bioprosthetic spacer such as Alloderm or Strattice to help relieve the tightness from the breast implant capsule.