Capsular fibrosis of the breast
Image: You can see an old-generation breast implant with a smooth wall, which was inserted at the end of the 1980s for breast augmentation. The implant was removed due to third degree capsular fibrosis. A deformation of the breast was hardly visible, but a moderate hardening was palpable. The slightly thickened capsule was completely dissected out and then slit. This allows the silicone implant to be clearly seen folded by the shrinkage of the capsule.
Capsular fibrosis: symptoms
Although the classification of capsular fibrosis (also known as capsular contracture) according to Baker is quite subjective, it offers a good way of assessing the severity of fibrosis based on the development of the following symptoms.
- Grade I – Stage without visible or palpable capsular fibrosis.
- Grade II – In this Baker stage, minimal capsular fibrosis is barely detectable. Only a discrete hardening of the breast implants can be felt.
- Grade III – Mild capsular contracture – Patients feel some tension or tightness.
- Grade IV – Immediately visible severe fibrosis, sometimes with pain.
The symptoms with which patients go to their doctor are most often a visible deformation and, in advanced stages, pain.
What is capsular fibrosis?
Around every implant (not just breast implants), the body forms an endogenous shell called a capsule. This is normally very delicate and cannot be felt. This delicate capsule is fused with the surrounding area and secures the position of the implants, especially when they are placed under the muscle, provided that the breast implants are rough and the capsule can grow into them easily. Rough implants are particularly advantageous for teardrop-shaped implants so that they cannot rotate due to ingrowth. This argument is not so important with round implants.
Capsular fibrosis after breast augmentation or breast reconstruction with breast implants leads to a thickening of the capsule due to increased connective tissue formation. In extreme cases, it can become several millimetres thick.
What theories are known about the cause?
To date, it has not been possible to assign a clear cause to capsular fibrosis. The less is known, the greater the number of theories and hypotheses. The following factors are associated with the disease:
- Silicone leakage through the shell of the breast implants
- A genetic tendency to develop capsular fibrosis
- Foreign body reaction
- Autoimmune disorders of the connective tissue
- Bruising
- Infection or contamination (coming into contact) with bacteria without visible infection. (2)
- Nature of the surface of the breast implants
There are indications that breast implants implanted under the pectoral muscle have a lower capsular contracture rate. This may be due to the protection against bacteria, as the muscle is very well supplied with blood. However, there are also those who believe that it could be due to the movement of the breast implants through the muscle.
Treatment of capsular fibrosis
Treatment is often only necessary in stages III and IV of capsular fibrosis. On the one hand, there is the option of a capsulotomy, i.e. incision of the capsule in several places, if the capsular fibrosis is moderate. On the other hand, there is capsulectomy, which involves removing the capsule. In this case, however, the part of the capsule lying on the chest is usually left in place. If the breast implants lie over the pectoral muscle, they can be moved under the pectoral muscle, as the rate of fibrosis is lower here. If capsular fibrosis occurs repeatedly, the only option is to remove the implants and then shape the breast by means of a breast lift.
Another alternative treatment is the use of polyurethane-coated implants. There is practically no fibrosis with these implants. The disadvantage is greater tissue loss if the implants have to be removed at short notice for very rare reasons.
