What Can Be Done to Prevent Encapsulation from Happening?

The rates of capsular contracture, or scar tissue around breast implants varies from surgeon to surgeon, but really should be about 2-4% across the board.  This can happen right after the surgery to years down the line.  Anytime you place something foreign in the body, whether it is a knee joint, a pacemaker, or breast implant, etc., your body produces a thin layer of scar tissue in reaction to the device.  Most of the time you never know it is there.  However, about 2% of women will develop thicker scar tissue that can actually distort the breast, make it firmer, and painful.  In general, it comes from either trauma and bleeding during the surgery or immediately afterwards, or the natural bacteria of your body.  No one can predict who it happens to or when it will happen.  It can be immediately after surgery to years down the line.  However, if a patient makes it to the three month mark after surgery and are not having any problems, chances are they will not have to deal with it.  I hope this helps.

The incidence of capsular contracture increases over time, just like the incidence of implant rupture.  Older implants have a higher chance of contracture than newer ones.  The best data available shows a 15% chance of capsular contracture at seven years after primary augmentation, similar with both gel and saline.  This means 85% of women do not get contracture by seven years.  More common for patients having reconstruction than augmentation, more common for augmentation-mastopexy than augmentation alone (my empirical observation), and more common if the augmentation is secondary for an initial capsular contracture.  Commonly coexists with silicone gel rupture.  Most commonly does not occur days or weeks after augmentation, but months or years after.

Any time a foreign object is implanted in the body, whether it is a pacemaker or a breast implant or an orthopedic device or anything else, the body responds by forming a thin, wispy, fibrous membrane around it. In most cases this membrane or 'capsule' stays thin and wispy, but in some cases over time the capsule may tighten around the implant and thicken, making the implant feel firm or even hard. In advanced stages the contracted capsule can even distort the shape and position of a breast implant. Capsular contracture can be treated, but it is a surgical treatment, so avoiding capsular contracture is all about avoiding another trip to the operating room.

Capsular contracture can occur on one or both sides, and while it can develop early (weeks) or late (years) after a breast augmentation surgery, in the vast majority of cases it is evident fairly early following the procedure. So the good news is that once you are six to 12 months out from your surgery, if your augmented breasts are soft and supple then they are likely to stay that way for the long term.

It is believed that capsular contracture is primarily a response to the presence of low-virulence or non-virulent bacteria (i.e. not the kind that generally produce an actual infection, with redness/tenderness/fever etc) that adhere to the implant surface on the day of surgery, and which over weeks and months following surgery stimulate the cells that make collagen (called fibroblasts) to make more collagen - thickening the capsule and stimulating it to contract and tighten around the implant. It is not an actual infection; there are no symptoms that this is going on, and taking antibiotics will not prevent the process or reverse it. The source of these non-virulent bacteria is thought to be the patient's skin, or the ductal systems of the breast that lead to the nipple, as both are normally colonized with bacteria.

Because plastic surgeons now have an understanding of some of the reasons why capsular contracture occurs, there are a number of measures, including use of the Keller Funnel, that can be taken to significantly reduce the likelihood that it will happen following breast augmentation surgery

This is a good question; unfortunately there is a lot of disagreement about the right answer. To the best of my knowledge, the rate of encapsulation increases based on the duration of time that the implants are in place. Exact numbers are not known but an estimation might be about 1% of patients per year may develop encapsulation–so, after 20 years you may have about 20% chance of developing encapsulation.

I also think that choice of surgeon, sub muscular placement of implants, massage and/or local or remote infections may be variables to consider.

I hope this helps

First, just a bit of terminology.  Everyone gets a capsule or 'encapsulation'.  The term refers to the normal scar tissue that forms around an implant.  Since any scar tissue has the ability to contract (shrink) there is the potential for the capsule to close in on the implant, squeezing it.  This capsule 'contracture' can be uncomfortable or possibly affect your shape.  In really bad cases it can even become painful.  The link below is to a part of my website where many questions about breast implant surgery are answered.

So, capsules happen to all implants...but capsule contractures are somewhat rare.  The risk is slightly higher with silicone implants, especially if they're placed over the muscle.  When they're under the muscle the risks are not that much different than saline implants.  With silicone implants, massaging the breasts seems to reduce the risk although, with implants under the muscle, the muscle is massaging the implants all day long (not the case for over the muscle placement.)  So, while massage is very helpful for over the muscle implants, the advantage when they're under the muscle is uncertain- but it couldn't hurt.

Other issues that affect the risk of capsule contracture are linked to techniques used by your surgeon when the implants are placed.  This is out of your control.  Capsule contractures can really form at any time.  I have seen them after only a few months (pretty rare) or years later.  Scott Newman, MD FACS

Hello,

The good and bad news, depends on how you look at it, is that you cannot really do anything to cause or prevent it.  Much of the potential source of capsule contracture happens during surgery and perhaps genetics/other body factors that you cannot control.  Massage may help but there is some disagreement about this.  I would not worry about it.  The chance of not getting a capsule contracture is in your favor.

All the best,

Dr Repta

All breast inplants encapsulate.  This is a process in which your body recognizes that the implant is not a normal part of your body and forms a capsule around it.  The problem arises when this capsule contracts forming a capsular contracture of which there are 4 grades.  Grades 1/2 are not particularly problematic, but grades 3 and 4 contractures cause odd shapes and, often, pain.  The best way to avoid a grade 3 or 4 contracture is to select an implant which is not overly large for your breast.