Silicone implants can last for many years. The first silicone breast implants were inserted in the early 1960’s and many of these are still going strong. However, as any plastic surgeon will tell you; silicone breast implants should not be considered ‘lifetime devices’. When a breast implant is inserted into the breast, the body forms a flimsy wall of scar around the implant to completely ‘wall off’ the implant. This flimsy wall of scar is known as a ‘capsule’. This capsule does not contract and so the implant remains soft. All women with silicone breast implants have a grade 1 capsule. At some stage in the future, this flimsy wall of scar may start to thicken and shrink around the implant, resulting in a capsular contracture. There are many reasons why a capsular contracture may develop. These include: trauma; infection; rupture; and wear and tear of the implant. Sometimes the capsule just occurs and the reason why is never identified.
Grade 2 Capsular Contracture
When a capsular contracture first occurs, the breast may initially feel a little harder that the other side, but the breast appears to be a perfectly normal shape. This is known as a grade 2 capsular contracture. Should a grade 2 capsular contracture occur, then it is a good idea to visit your plastic surgeon to get your implants checked out. Usually, at this stage, it is perfectly safe to leave the implant alone. It will not cause you any health issues. Most women with grade 2 capsular contractures choose to simply live with a slightly harder breast. Some women with a grade 2 capsular contracture dislike the firmness and choose to have surgery to correct it. It is very rare for a grade 2 capsular contracture to resolve spontaneously to leave a perfectly soft breast. Many grade 2 capsular contractures will remain hard but will not progress to a grade 3 capsular contracture.
Grade 3 Capsular Contracture
Some grade 2 capsular contractures will continue to contract and eventually the breast will distort or change shape. This is now known as a grade 3 capsular contracture. Often you can see the hard, encapsulated implant, or the implant appears to be smaller and sits higher within the breast (see picture). At this stage, it is still medically safe to leave this degree of capsular contracture, although most women will now decide to have surgery to correct their breast shape. It is very rare for a grade 3 capsular contracture to soften and change back to a grade 2 capsular contracture.
Grade 4 Capsular Contracture
A grade 2 or grade 3 capsular contracture may eventually become painful. The pain is often described as a dull ache which may spread from the breast into the armpit or even down the arm. The pain can vary from mild discomfort to quite severe pain. When any level of capsular contracture becomes painful, it is known as a grade 4 capsular contracture. Most women with a grade 4 capsular contracture will choose to have surgery to alleviate the pain.
There is no good medical treatment to correct or reverse capsular contracture. Surgery to correct this condition involves; removing both the wall of scar (the capsule) and the old implant; and then dealing with the empty breast.
- Explantation and capsulectomy: This can be done through the same scar that the implant was inserted through, by first removing the old implant and then cutting out the old scar from the lining of the empty pocket.
- Explantation and En-bloc capsulectomy: this removes the capsule and the old implant as a single block of tissue. It is generally considered safer to undertake an en-bloc capsulectomy, to avoid opening the scar tissue and spilling any contents of the capsule into the breast cavity. However, this requires a bigger scar to remove the en-bloc capsule and implant together (because this hard block of tissue cannot be squashed to get it out through the original small incision).
A decision then needs to be made on what to do with the remaining breast. Options include:
- Leaving the breasts smaller and empty: some women choose not to have implants re-inserted. In these cases the shape of the final breast is a little unpredictable. The final shape depends, to some degree, upon the amount of natural breast tissue and the size of the original implant.
- A new implant inserted – this implant can be the same size or a bigger or smaller as required. If the same sized implant is chosen.
- Fat grafting – it is possible to augment the breast by taking fat from the tummy or thigh area and injecting this into the breast. This avoids having an implant and thus there is no risk of recurrent capsular contracture.
- Mastopexy – to reshape the breast (with or without a new implant)