After breast implants are placed during breast augmentation surgery, the body makes a capsule of fibrous tissue around them. This is a normal reaction of the body to foreign material such as the silicone shell of the breast implant. Usually it does not cause a problem, as it is underneath the breast tissue and not an excessively thick layer.
Some people make a thicker and tighter than usual capsule around the breast implant – capsular contracture. This is a complication of breast implants that can occur in the long term after augmentation surgery, although it can happen within the first year. In the initial stages, the affected breast feels firmer than expected but the capsule is not visible. In more severe cases, as well as feeling firm, a visible tightening and distortion of the breast is present. In the most severe cases, the breast is painful as well as feeling hard and having a visible distortion.
The treatment for capsular contracture is surgery to remove the implants and releasing the tightness of the capsule – capsulotomy or removing as much of the hard capsule around the implant as possible – capsulectomy. New implants can be inserted to replace the previous implants but if possible they are placed in a fresh location. For example, if the old implants were placed directly underneath the breast tissue, the new implants may be placed underneath the pectoralis muscle, which lies beneath the breast. It may be necessary to change to a different size or style of implants and it may be necessary to perform a breast lift or mastopexy as well. This is because there may be loose skin after the surgery to remove the old implants and capsule and the breast shape and size may have been significantly distorted by the capsular contracture. Some patients opt not to have implants replaced.
Surgery for capsular contracture is longer and more complicated than the original implant surgery and the risk for further complications higher than for the original surgery. You are more likely to produce fluid in the breast and need surgical drains for longer afterwards and you are at risk for the capsular contracture reforming. Should you be unlucky enough to get an infection postoperatively, the implants may need to be removed and left out for a period of time. However, in general it is successful in treating the problem of capsular contracture.
Recovery after this type of surgery is similar to the other types of cosmetic breast surgery in terms of wearing a non-underwired supportive bra for six weeks and allowing a recovery time of about six weeks before returning to exercise and completely unrestricted activity.