Capsular contracture
Encyclopedia
Immune system
An immune system is a system of biological structures and processes within an organism that protects against disease by identifying and killing pathogens and tumor cells. It detects a wide variety of agents, from viruses to parasitic worms, and needs to distinguish them from the organism's own...
to foreign materials in the human body. Medically, it occurs mostly in context of the complications from breast implants and artificial joint
Joint replacement
Replacement arthroplasty [from Greek arthron, joint, limb, articulate, + -plassein, to form, mould, forge, feign, make an image of], or joint replacement surgery, is a procedure of orthopedic surgery in which the arthritic or dysfunctional joint surface is replaced with an orthopaedic prosthesis...
prosthetics.
The occurrence of capsular contraction follows the formation of capsules of tightly-woven collagen
Collagen
Collagen is a group of naturally occurring proteins found in animals, especially in the flesh and connective tissues of mammals. It is the main component of connective tissue, and is the most abundant protein in mammals, making up about 25% to 35% of the whole-body protein content...
fibers, created by the immune response to the presence of foreign objects surgically installed to the human body, e.g. breast implants, artificial pacemaker
Artificial pacemaker
A pacemaker is a medical device that uses electrical impulses, delivered by electrodes contacting the heart muscles, to regulate the beating of the heart...
s, orthopedic prostheses
Orthopedic surgery
Orthopedic surgery or orthopedics is the branch of surgery concerned with conditions involving the musculoskeletal system...
; biological protection by isolation and toleration. Capsular contracture occurs when the collagen-fiber capsule tightens and squeezes the breast implant; as such, it is a medical complication that can be very painful and discomforting, and might distort the aesthetics of the breast implant and the breast
Breast
The breast is the upper ventral region of the torso of a primate, in left and right sides, which in a female contains the mammary gland that secretes milk used to feed infants.Both men and women develop breasts from the same embryological tissues...
. Although the cause of capsular contracture is unknown, factors common to its incidence include bacterial
Bacteria
Bacteria are a large domain of prokaryotic microorganisms. Typically a few micrometres in length, bacteria have a wide range of shapes, ranging from spheres to rods and spirals...
contamination, rupture of the breast-implant shell, leakage of the silicone-gel filling, and hematoma
Hematoma
A hematoma, or haematoma, is a localized collection of blood outside the blood vessels, usually in liquid form within the tissue. This distinguishes it from an ecchymosis, which is the spread of blood under the skin in a thin layer, commonly called a bruise...
.
Moreover, because capsular contracture is a consequence of the immune system defending the patient’s bodily integrity and health, it might reoccur, even after the requisite corrective surgery for the initial incidence. The degree of an incidence of capsular contracture is graded using the four-grade Baker scale:
- Grade I — the breast is normally soft and appears natural in size and shape
- Grade II — the breast is a little firm, but appears normal
- Grade III — the breast is firm and appears abnormal
- Grade IV — the breast is hard, painful to the touch, and appears abnormal
The surgical implantation methods that have reduced capsular contracture include submuscular breast implant placement, using either textured or polyurethane-coated implants,
limited handling of the implants, minimal contact with the chest wall skin before their insertions, and irrigating the surgical sites with triple-antibiotic solutions. The correction of capsular contracture might require the surgical removal (release) of the capsule, or the removal, and possible replacement, of the breast implant, itself. Closed capsulotomy (disrupting the capsule via external manipulation), a once-common maneuver for treating hard capsules, was discontinued because it might rupture the breast implant. Non-surgical methods of treating capsules include massage, external ultrasound
Medical ultrasonography
Diagnostic sonography is an ultrasound-based diagnostic imaging technique used for visualizing subcutaneous body structures including tendons, muscles, joints, vessels and internal organs for possible pathology or lesions...
, treatment with leukotriene
Leukotriene
Leukotrienes are fatty signaling molecules. They were first found in leukocytes . One of their roles is to trigger contractions in the smooth muscles lining the trachea; their overproduction is a major cause of inflammation in asthma and allergic rhinitis...
pathway inhibitors (e.g. Accolate, Singulair), and pulsed electromagnetic field therapy.
The Mentor Worldwide LLC corporation, one of the two, U.S. FDA-approved breast-implant device manufacturers, conducted a study of the medical complications suffered by breast implantation surgery patients. In March of 2000, at a Food and Drug Administration presentation, the Mentor report indicated that 43 per cent of patients with saline breast implants reported medical complications occurring within three years of the surgery; moreover, 10 per cent of that percentage group complained of capsular contracture.
Sources
- Section on Complications from the FDAFood and Drug AdministrationThe Food and Drug Administration is an agency of the United States Department of Health and Human Services, one of the United States federal executive departments...
Breast Implant Consumer Handbook - 2004. Most of the above text was copied verbatim from this public domain source. - Safety of Silicone Breast Implants. Institute of Medicine National Academy Press, Washington, D.C. 2000.
- Breast Augmentation and Breast Implants Information Website - ImplantInfo by Nicole