During the healing process after a breast augmentation your body naturally produces scar tissue around your breast implant. This is totally normal!
This scar tissue we call a “capsule” is normally thin and soft, so we don't notice it, and it's actually really important as it holds your breast implant in place in the breast pocket.
Sometimes though, the body's natural process of producing scar tissue around a breast implant can go a bit into overdrive.
If the body produces too much scar tissue it’s called a capsular contracture.
Capsular contracture can happen after any surgery... not just after a breast augmentation. It's your body's overreaction to a foreign object.
What is capsular contracture?
If a capsular contracture occurs the capsule of scar tissue around the breast implant contracts (tightens and/or hardens) and causes the breast to become hard, change in shape and can even be painful.
It's unfortunately the most common breast augmentation complication. Around 1 in 10 women with breast implants experience capsular contracture and it's the main reason for revision surgery.
We don't know exactly what causes capsular contracture but it's been thought to have been contributed to bacterial contamination during surgery - basically, bacteria get inside your surgical area.
Bacteria stick around and cause an infection in the area. It's not always an obvious infection (so you may not get a fever, for example) but as your body fights the infection it produces more and more scar tissue as a form of protection.
In most cases capsular contracture starts during the healing process so would be noticeable within a few months of surgery. However, it can happen at any time (and in one or both breasts)... even years after a breast augmentation surgery.
Who gets it?
It's not possible to predict precisely who will develop capsular contracture as it can affect any woman with breast implants. There are, however, some things that seem to increase your risk of developing capsular contracture:
Implants too large for your body - if the breast tissue is overly stretched by a breast implant it may cause your body to produce more scar tissue.
Nipple or armpit incision sites - milk ducts in the nipple contain bacteria and the way an implant is placed through an armpit incision means more chance of bacterial contamination
Implants placed over the muscle have a higher likelihood of developing capsular contracture
A hematoma or seroma forming after surgery
Family history of autoimmune disease or thick scarring - both of these increase the risk of developing capsular contracture
It's not always possible to say what caused a capsular contracture but whatever the cause there are options to treat it.
What to look out for
Breast implants won't ever feel 100% natural BUT they shouldn't be hard or uncomfortable.
You're actually the one who's likely to notice capsular contracture first but the only way to truly detect it is through a physical exam at your surgeon's office. You might notice a slight increase in firmness, a change in position or pain in one or both breasts.
A Board Certified plastic surgeon know what to look and feel for. Here is how capsular contracture is graded:
All breast implants without complications are considered Grade I.
Grade II is not harmful to you or your body but it may be uncomfortable, causing pain and a change in the look of your breasts (not ideal when you had a breast augmentation to make your boobies look great!).
Higher grades III & IV of capsular contracture pose more of a risk. If the tightness of the scar capsule is too much, it will be more painful, distorted, and may cause a breast implant to rupture.
Although surgical complications can sound scary, having the knowledge and awareness is you first line of defense! If you know what to look out for you are more likely to reach out for advice and reassurance from your plastic surgeon sooner than later.
Plastic surgeons can use special techniques to limit the chances of bacterial contamination during surgery, like the use of a keller funnel. Some breast implant manufacturers (e.g Sientra) include coverage for capsular contracture in their warranties.
You know your breasts better than anyone so if something doesn't look or feel right to you, reach out to your plastic surgeon. Early intervention is best.