The normal tissue around the implant is soft and relatively mobile. When the capsular contracture occurs, the tissues that surround the silicone implant tend to become solid, thickened and they tighten the implant from all sides.
The breasts become hard, and the patients themselves notice that something is wrong. The position of the implant is quite often the first sign of the capsular contracture, in the way that one implant on the chest stands closer to the shoulders than the other, as if it was raised from the bottom and clenched.
All these years attempts to prevent capsular contracture have been mentioned at both congresses and conferences but there is still no definite solution, though there have been a large number of proposals.
Some of the solutions include the use of drains during the operation, so as to keep as little blood as possible around the implant, but at the same time it is noted that the drain can be the source of infection that might affect the formation of the capsular contracture. Also, some authors advocate early exercise and movement, while others forbid them altogether.
What all authors agree on is that the polyurethane implants currently have the lowest incidence of the capsule contracture, roughly half as many as conventional silicone implants, giving not that much conspicuous appearance. For this reason, there is a tendency for polyurethane implants to be used not only for complicated secondary options, but also for primary augmentations in all patients.
What can be done when capsular contraction occurs?
The moment when the appearance of the breast becomes unacceptable, it’s a reoperation that should be done. The existing capsule should be completely removed, and the implants should, if possible, be replaced. If an existing implant is returned, it usually rotates in the pocket that is now larger than before. It’s a misassumption that external breast massage will affect the tearing up of implant tube, and mini-invasive, 10 – minute operations, in which the capsule is slightly cut off, but not completely removed, proved to be unsuccessful as the contracture is bound to return again.
Also implants and a capsule can be removed, while the new one needn’t to be inserted, but then the breast usually looks worse than before the first surgery due to atrophy of the breast tissue.
The third option, according to many authors, is simultaneously the best and the most complicated one. It is a complete reoperation which includes the removal of the capsule, the pocket formation and the insertion of the new polyurethane implants. When capsule is removed, a part of the breast tissue is usually removed as well, so in the second act we often have to fill in the uneven surface with fat tissue. Although this operation can last up to 4 hours, the end result justifies the effort – the patient gets the look she desires.