page_title: Breast augmentation
section_title: Capsular contracture
hierarchical_section_title: Breast augmentation / Surgical procedures / Capsular contracture
caption_attribution_description: The photograph shows grade IV capsular contracture in the right breast of a 29-year-old woman seven years after subglandular placement of 560cc silicone gel-filled breast implants.
context_page_description: Breast augmentation and augmentation mammoplasty is a cosmetic surgery technique using breast-implants and fat-graft mammoplasty techniques to increase the size, change the shape, and alter the texture of the breasts of a woman. Augmentation mammoplasty is applied to correct congenital defects of the breasts and the chest wall. As an elective cosmetic surgery, primary augmentation changes the aesthetics – of size, shape, and texture – of healthy breasts.
  The surgical implantation approach creates a spherical augmentation of the breast hemisphere, using a breast implant filled with either saline solution or silicone gel; the fat-graft transfer approach augments the size and corrects contour defects of the breast hemisphere with grafts of the adipocyte fat tissue, drawn from the person's body.
  In a breast reconstruction procedure, a tissue expander is sometimes put in place and inflated with saline to prepare the recipient site to receive and accommodate the breast implant prosthesis.
context_section_description: The human body's immune response to a surgically installed foreign object – breast implant, cardiac pacemaker, orthopedic prosthesis – is to encapsulate it with scar tissue capsules of tightly woven collagen fibers, in order to maintain the integrity of the body by isolating the foreign object, and so tolerate its presence. Capsular contracture – which should be distinguished from normal capsular tissue – occurs when the collagen-fiber capsule thickens and compresses the breast implant; it is a painful complication that might distort either the breast implant, or the breast, or both.
  The cause of capsular contracture is unknown, but the common incidence factors include bacterial contamination, device-shell rupture, filler leakage, and hematoma. The surgical implantation procedures that have reduced the incidence of capsular contracture include submuscular emplacement, the use of breast implants with a textured surface (polyurethane-coated); limited pre-operative handling of the implants, limited contact with the chest skin of the implant pocket before the emplacement of the breast implant, and irrigation of the recipient site with triple-antibiotic solutions.
  The correction of capsular contracture might require an open capsulotomy (surgical release) of the collagen-fiber capsule, or the removal, and possible replacement, of the breast implant. Furthermore, in treating capsular contracture, the closed capsulotomy (disruption via external manipulation) once was a common maneuver for treating hard capsules, but now is a discouraged technique, because it can rupture the breast implant. Non-surgical treatments for collagen-fiber capsules include massage, external ultrasonic therapy, leukotriene pathway inhibitors such as zafirlukast (Accolate) or montelukast (Singulair), and pulsed electromagnetic field therapy (PEMFT).
caption: Breast-implant failure: Capsular contracture is a medical complication, in this case, a Baker scale Grade IV contraction, of a subglandular silicone implant in the right breast.
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