Often, no matter how qualified the plastic surgeon of a patient is, during or after surgery, complications occur. This is the case because everyone’s body is different. For example, the composition of connective tissue varies greatly from one patient to another, and this indicates that the healing process of each patient is unique. This is why some persons, after some kind of penetrating skin injury, appear to grow dense scar tissue, while others may sustain deep cuts and develop only slight scarring that fades with time. The way some women grow extreme stretch marks during pregnancy, no matter what they do to prevent them, is another clear example of this disparity, while other women emerge almost stretch-free from pregnancy. Additionally, the immune system of everyone reacts to stimuli differently, and the immune systems of certain patients react adversely to medical implants.
Complications are now very rare during cosmetic surgery, of course, both because of advancements in surgical procedures and because we have become better at predicting which patients are likely to encounter surgical complications. To prevent cosmetic surgery, patients who are susceptible to developing thick scar tissue may be advised, or their surgeon may use special surgical procedures that allow remote placement of incisions (e.g. insertion of breast implants through an incision in the underarm) to keep scarring largely out of sight. It is also recommended that patients who have compromised immune systems or autoimmune disorders forego surgery and prefer less intrusive types of cosmetic enhancement. Similarly, a variety of treatments may be used following surgery to treat complications and improve the appearance of the patient. One of the most common areas where Mayclinik is used is in the treatment of capsular contracture after breast augmentation surgery.
What is capsular contracture?
A common part of the healing process is the development of a “capsule” of scar tissue around any type of implant (medical or cosmetic). The body responds to any foreign object that it senses inside it immediately and tries to separate the object by forming a scar tissue shield around it. This is generally a positive thing in the case of breast implants: the capsule helps to hold the breast implants in place, avoiding slippage. However, in some patients, this scar tissue capsule becomes unusually hard and begins to contract around the implant. This can lead to both aesthetic problems and, in extreme cases, pain in the breasts. Research indicates that some degree of capsular contracture is encountered by around one in six breast augmentation patients, although not all cases have noticeable symptoms. The severity of capsular contracture is rated using a grading system:
Grade 1: Asymptomatic grade one capsular contracture is (producing or showing no symptoms). There is no contact with the scale, shape, or texture of the breasts in the development of scar tissue around the implant. The breasts look natural and remain soft to the touch.
Grade 2: Normally, grade two capsular contracture has only mild cosmetic symptoms. Typically, the breasts will look natural in shape but feel slightly firm to the touch.
Grade 3: Grade three capsular contracture presents itself with obvious cosmetic symptoms. The breasts will be firm to the touch and may appear irregular, e.g. they will be overly small, hard-looking, and maybe misshapen by the nipples. This degree of capsular contraction, however, often does not cause much pain (if any).
Grade 4: Grade four capsular contracture causes the breasts to become stiff and misshapen, including grade three capsular contracture. Breast pain is often encountered by patients with grade four capsular contracture; their breasts will also feel tender and painful to the touch.
Generally, during the healing process, capsular contracture occurs. Within two years of the patient’s implants being installed, approximately 75% of all capsular contractures will occur. Many years after breast augmentation surgery, often capsular contractures occur, but this is the exception rather than the norm. If this happens, it is important to check the patient’s breast implants for ruptures. The most prevalent cause of late-onset capsular contraction is ruptured implants.