Understanding Capsular Contraction with Leeds OncoPlastic Breast Surgeon Philip Turton
Breast augmentation is a highly effective and popular procedure, offering many women excellent and long-lasting results.
For most, the process integrates seamlessly into the body, with a natural layer of tissue forming around the implant, known as the capsule. This occurs with any implanted material, whether it’s a pacemaker or an artificial hip. However, in some cases, this capsule can tighten or thicken over time, leading to a condition called capsular contracture.
Philip Turton, a leading oncoplastic surgeon based in Leeds, is here to help you navigate the nuances of breast augmentation and any complications that may arise, including capsular contracture.
Below, we explore the causes, stages, and treatment options for this condition.
What is Capsular Contracture?
Capsular contracture occurs when the capsule of fibrous tissue surrounding the breast implant thickens or tightens.
This condition can happen at any time but is most common within the first few months after surgery or several years later.
The capsule, which initially forms to support the implant and create a natural feel, may shrink in some individuals. This shrinkage can result in increased firmness of the implant and, in severe cases, discomfort or pain. Over time, the implant may feel overly firm or develop small angulated edges called knuckles or simply an unnatural appearance.
Mr. Turton helps you Understand how Capsular Contracture Occurs
During breast augmentation surgery, a pocket is created under the breast to house the implant. As the body heals, it produces a thin fibrous scar tissue layer that forms the complete capsule around the implant.
When heavily textured (rough surface) breast implants were previously used it was because the manufacturer felt this would reduce capsular contracture by disrupting the collagen in the scar tissue from pulling tighter.
And the capsule would often integrate like velcro onto the textured surface making it feel like one with the beast, and reducing malposition.
The less textured implants or the smooth (no texture) surface implants in use in this day and age, do not adhere to the scar tissue at all.
For some individuals, this tissue called the capsule, thickens excessively, or simply contracts without thickening, around the implant.
Capsular contracture can result in varying degrees of firmness and visual alteration. In severe cases, the condition may cause the breast to feel hard, appear misshapen, or develop a spherical “ball-like” look. This tightening of the capsule is graded to determine the severity.
Grading Capsular Contracture
There are probably several causes that affect some patients and not others. There are some factors that may increase the risk of capsular contracture.
Capsular contracture is more likely following an infection. It may occur following subclinical infection. Subclinical mastitis with pregnancy or breast feeding may precede it. Dental infection, gingivitis, abscess or dental treatment like a root canal. Possibly other viral or bacterial infections that we know little about. Sub-glandular placement
Smooth breast implants placed above the muscle tend to have higher capsular contracture rates, versus smooth breast implants placed behind the muscle, which is also known as sub-muscular or dual plane placement. But remember there are other pros and cons to be taken into account in deciding on implant texture and placement, and your specialist will discuss these.
This is a collection of blood around the implant. It could cause an inflammatory reaction, which could theoretically predispose to capsular contracture. The evidence for this is not based on studies as they are too lacking in the literature, but based on physiological processes of wound healing, and one of Mr. Turton’s theories. It is advisable to place a temporary drain at the time of surgery which is removed immediately before your discharge home. This removes even small volumes of blood which otherwise would be left around your implant by those surgeons that don’t routinely drain.
The smooth surface implants seem to be associated with a significantly higher capsulation rate than the rough surface type if placed in the sub-glandular position. The rates are otherwise similar if placed sub-pectorally. These rough surfaced implants were a new design change introduced over 20 years ago. The process called “texturing” makes the surface feel slightly different when held in the hand, but they usually feel quite similar inside the body. Different manufacturers have chosen different techniques to texture implants, and there is a wide choice now. Due to concerns that too much texturing might cause a slightly higher risk of a very rare cancer or lymphoma (BIA-ALCL) surgeons will talk to you about texturing, the pros and cons of the different types and what might be most beneficial in your circumstance. Sometimes using a totally smooth implant under the muscle is preferred, or otherwise a microtextured implant above or under the muscle is used. Only rarely these days since 2019, will we recommend to use the higher grades of texture or polyurethane coated implants due to the potential concerns. Trade-offs and individual informed patient choice also have to be considered as sometimes those implants are an option for a difficult cosmetic situation. The original rational for texture was to inhibit the capsulation process and so dramatically reduce its occurrence. The higher grade of textured implants also united better to the back of the breast tissue reducing risks of a rotation of a shaped implant or general movement.
A ruptured implant or one that is bleeding small amounts of gel into the area around the implant might incite a chronic inflammatory response that leads to your capsule tightening around the implant. If this goes on for a prolonged amount of time, the capsule might thicken and after years it may even begin to calcify forming a very hard surface in places and squeeze the implant into the shape of a smaller ball. Of note is that if you have had any previous capsulation it is much more likely to occur again. There may be a genetic reason for this related to wound healing. This is unknown, though. If you do get recurrent capsular contraction you should think about permanently removing your implants and accepting it is not for you.
Other autoimmune, inflammatory or chronic inflammatory conditions in the body that are not well researched; these may increase problems with implants, including capsular contraction.
How does Mr. Turton treat capsular contraction of breast implants?
The first advice is permanently to stop smoking if you are a smoker.
If there are no symptoms and the cosmetic result remains excellent you do not need to have anything done.
It doesn’t always progress. It is also important to know that it is not necessarily associated with any implant rupture. It is also not commonly associated with any unrecognised toxic or nasty systemicinflammatory process, or an implant lymphoma. In other words, capsular contracture, for most patients, is a benign process.
If it causes discomfort, pain or an unwanted cosmetic result then a careful clinical review with a specialist is required. You may need breast imaging to check the implant (silicone sequence breast MRI). Surgery is then the best way to deal with it.
No one should undergo the previously used but now out-dated technique of closed capsulotomy (the hardened implant was manually squeezed from the outside, to tear the scar envelope, but this could damage the implant, rupturing it).
Open capsulotomy, partial or full capsulectomy (e.g. total en-bloc capsulectomy): This involves a general anaesthetic. The previous incision is usually reopened and lengthened to improve access.
The capsule is either incised if it is very minor. But otherwise Mr Turton would look at partial, sub-total, or totally excising the capsule depending on likely cause, circumstance, technical possibility and safety. Either total en-bloc or after removal of the implant depending on reasons. Mr Turton is extremely experienced in these judgements and all of these techniques. Of particular relevance is how the breast may be more flaccid, looser and lower are capsulectomy. Therefore, because a lot of patients do not want more breast droop, Mr Turton has a special technique called Explantation and mastopexy, in which he can usually remove the capsule simultaneously with breast reshaping- but, it is better not to replace the implant for at least 6-months. Some patients have such a good shape after this (if they have reasonable breast volume) that they are happy to stay implant free! Patients can usually decide after 3-months, and if happy can spare themselves the cost of a second operation, and spare themselves of future implant problems too.
If a patient still has pert breasts and capsular contracture, and they have good soft tissue thickness around the implant, then in those circumstances a new implant can be reinserted if the patient wants to have replacement implants at the same time. After surgery, the breasts will feel softer and quite often they look still slightly lower and you may feel you have lost the fullness that you used to have, especially in the upper breast (the previously contracted capsule had acted to keep the breasts artificially high, so after it is removed the breasts drop back to their normal position). Careful discussions are always needed to understand these options and what will work best for an individual.
Lifestyle Changes: Smokers should cease nicotine products, smoking or vaping to reduce risks. If the condition causes no symptoms and the cosmetic result is acceptable, no immediate treatment may be necessary.
Surgical Intervention:
Open Capsulotomy: The capsule is surgically incised to release tension. Minor cases.
Partial or Total Capsulectomy: The capsule is partially or completely removed, often alongside implant replacement.
Morte commonly with mastopexy and no replacement implant. This is performed under general anesthesia for optimal comfort and precision.
It is essential to avoid outdated techniques like closed capsulotomy, which involve externally squeezing the implant to tear the capsule—this can damage the implant and is never recommended.
Why Choose Philip Turton?
Philip Turton brings years of expertise and patient-centered care to every procedure. With over 21-years experience and thousands of operations, Mr Turton has seen almost every combination of scenarios.
His tailored approach ensures that each patient receives the best possible outcome, whether through explantation and mastopexy, breast augmentation, further revision surgery, or addressing complications like recurrent capsular contracture.
By combining advanced surgical techniques, established over more than two decades as a specialist, with a comprehensive understanding of patient needs, Mr. Turton delivers results that are both aesthetically optimised, with the goal to be pleasing and safe.
Contact Us Today
If you have concerns about capsular contracture or wish to explore removal and uplift, capsulectomy, or redo breast augmentation options, contact Philip Turton’s clinic in Leeds.
Whether you’re seeking treatment for an existing condition or considering breast implants, Mr. Turton and his team are here to guide you through every step of the journey.
Take the first step towards enhanced confidence and well-being. Schedule your consultation today.
Capsulated Implant
The majority of women have a very nice and long lasting result from breast augmentation. A thin layer of healthy tissue soon forms around your new breast implant to make it part of you. This is called the capsule.
This occurs around any implanted material whether it is a pacemaker or an artificial hip. In some people, this tissue may thicken with time and the term for this is “capsulation “or “capsular contraction.”
Capsular contracture is the most common complication that occurs with breast augmentation and can happen at any time. It seems to be more common in the first few months after surgery, but the incidence then rises again several years after surgery.
How does Capsular Contraction occur?
At the time of the implant surgery, a pocket is made under the breast for the implant. The capsule that forms is made of fibrous tissue. Some patients lay down more collagen and scar tissue in this capsule, which naturally tends to shrink with time. In most people, this may cause a slight increase in firmness of the implant, or it may only be noticed by your specialist. In some people, the capsule will tighten gradually, and squeeze the implant. This makes the breast implant feel hard and alters the appearance of the breast. In the later stages, the implant feels very firm and may take on a ball-like look. Capsular contracture like this usually produces pain and discomfort.
How is capsular contraction graded?
Grade I
Breast is soft and looks natural (this means there is no capsulation!)
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
What causes capsular contraction?
There are probably several causes that affect some patients and not others. There are some factors that may increase the risk of capsular contracture.
Smoking
The rate of capsular contraction is twice as high in smokers. Mr Turton advises all of his patients not to smoke.
Infection
Capsular contracture is more likely following an infection. It may occur following sub-clinical infection.
Sub-glandular placement
Breast implants placed above the muscle tend to have higher capsular contracture rates, versus breast implants placed behind the muscle, which is also known as sub-muscular placement. But remember there are other pros and cons to be taken into account in deciding on implant placement, and your specialist will discuss these.
Haematoma
This is a collection of blood around the implant. It can cause an inflammatory reaction, which can lead to capsular contracture. It is advisable to place a temporary drain at the time of surgery which is removed immediately before your discharge home. This removes even small volumes of blood which otherwise would be left around your implant by those surgeons that don’t routinely drain.
Smooth Surface Implants
The smooth surface implants seem to be associated with a significantly higher capsulation rate than the rough surfaced type if placed in the sub-glandaulr position. The rates are otherwise similar if placed sub-pectorally. These rough surfaced implants were a new design change introduced over 10 years ago. The process called “texturing” makes the surface feel slightly different when held in the hand, but they feel quite similar inside the body. Different manufacturers have chosen different techniques to texture implants, and there is a wide choice now. Due to concerns that too much texturing might cause a slightly higher risk of a very rare lymphoma (BIA-ALCL) surgeons will talk to you about texturing, the pros and cons of the different types and what might be most beneficial in your circumstance. Sometimes using a totally smooth implant under the muscle is preferred, or otherwise a micgrotextured implant above or under the muscle is used. Only rarely these days in 2019, will we recommend to use the higher grades of texture due to the potential concerns. The original rational for texture was to inhibit the capsulation process and so dramatically reduce its occurrence. The higher grade of textured implants also united better to the back of the breast tissue reducing risks of a rotation of a shaped implant or general movement.
Ruptured or leaking implant
A ruptured implant or one that is bleeding small amounts of gel into the area around the implant might incite a chronic inflammatory response that leads to your capsule tightening around the implant. If this goes on for a prolonged amount of time, the capsule might thicken and after years it may even begin to calcify forming a very hard ball. Of note is that if you have had any previous capsulation it is much more likely to occur again. There may be a genetic reason for this related to wound healing. This is unknown, though. If you do get recurrent capsular contraction you should think about permanently removing your implants and accepting it is not for you.
How do you treat capsular contraction of breast implants?
My first advice is to stop smoking if you are a smoker. If there are no symptoms and the cosmetic result remains excellent you do not need to have anything done. It doesn’t always progress. It is also important to know that it is not usually associated with any implant rupture, a toxic or nasty systemic inflammatory processes, or an implant lymphoma.
If it causes discomfort, pain or an unwanted cosmetic result then a careful clinical review with a specialist in required. You may need breast imaging. Surgery is then the best way to deal with it.
No one should undergo the previously used but now out-dated technique of closed capsulotomy (the hardened implant was manually squeezed from the outside, to tear the scar envelope, but this could damage the implant).
Open capsulotomy, partial or full capsulectomy (e.g. total en-bloc capsulectomy): This involves a general anaesthetic. The previous incision is usually reopened and the capsule is either incised, or partly or totally excised either en-bloc or after removal of the implant depending on reasons.
A new implant can be reinserted if the patient wants to have replacement implants. After surgery, the breasts feel softer and quite often they look slightly lower and you may feel you have lost the fullness that you used to have, especially in the upper breast (the previously contracted capsule had acted to keep the breasts artificially high, so after it is removed the breasts drop back to their normal position).
