One of the most common complications following a breast augmentation procedure is the condition referred to as "capsular contracture." Any time a foreign object, like a breast implant, is placed in the body a lining or "capsule" forms around it. (This also happens with pacemakers and artificial joints.) The capsule is the body’s attempt to protect itself from the presence of a foreign element and forms naturally during the healing process. It is composed of tissue with a fibrous texture not unlike that of a scar.

Normally the capsule remains open. Problems occur in some individuals, however, when the capsule tightens around the implant. The resulting pressure makes the implant hard or firm to the touch and distorts its appearance. When this contracture reaches later stages of development, the implant can look and feel like a ball. Understand, however, that this is not a malfunction or rupture of the implant, but rather a natural bodily function -- the shrinking of scar tissue -- gone awry.

Contractures are rated on the Baker scale in an ascending level of seriousness:

• Grade I - The normal condition of a soft, natural breast with an open capsule.


• Grade II - A slight firmness of the breast, which continues to maintain a natural appearance.


• Grade III - The breast is firm and beginning to show manifestations of distortion.


• Grade IV - The breast becomes hard and unnatural in appearance with pain and discomfort present.
  

Unfortunately there is no clear understanding of what causes capsular contracture in some patients. There are, however, some precautions and care measure that can be taken to help prevent the condition.

• Scrupulous post-surgical care. - By keeping the incision clean, you minimize the degree to which the body interprets the surgery as an insult. Infection must be avoided at all costs.


• Implant texture. - Some health care professionals feel that the use of a textured, rather than a smooth-surfaced implant prevents contractures.


• Implant placement. - Sub-pectoral placement (under the muscle) is preferred, allowing the muscle to massage the implant and keeping it away from the bacteria present in the milk glands.


• Use of Vitamin E. - Vitamin E will soften the fibrous tissue that makes up the capsule, but should not be used until two weeks after the surgery as it effects the ability of the blood to clot.


• Post-surgical massage. - Patients should discuss the appropriate degree of pressure and motion to be used with their surgeon.


• Compression. - Both a compression bra and a series of compression exercises can be used to help the capsule remain open.


• No cigarettes. - Smoking should always be avoided after any surgery as nicotine causes the blood vessels to contract thus slowing the healing process.

The good news is that capsular contracture, when present, can be addressed with a variety of surgical and non-surgical methods. These include:

• Open capsulotomy. - A small, inconspicuous incision allows the surgeon to cut the scar tissue thus releasing the pressure exerted on the implant.


• Open capsulectomy. - The entire capsule is removed allowing a new, healthy capsule to form in its place. This option carries the greatest rate of success.


• Closed capsulotomy. - Pressure is applied to the implant in an effort to rupture the capsule. This method is rarely used due to its low degree of effectiveness.


• External ultrasound. - Ultrasound treatments are used to reduce both inflammation and swelling and to stimulate normal tissue production. This method can be used as both a treatment and a preventive option.


• Antibiotics. - Although your doctor may try to treat the contracture with antibiotics, the drugs tend to address only the pain and swelling and do not remedy the contracture itself.


• Accolate. - Although the Federal Drug Administration has not approved the use of the asthma drug Accolate for this purpose, it has been found to reverse contractures that are in the early stage of formation. This is, however, an "off label" use of the drug and should be approached with caution.
  

The best method to combat the formation of capsular contracture is attentive post-operative care. By following, to the letter, all recommended measures, most breast enhancements patients will heal without the presence of this complication.