Capsular Contracture
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Capsular contracture is a response of the
immune system The immune system is a network of biological processes that protects an organism from diseases. It detects and responds to a wide variety of pathogens, from viruses to parasitic worms, as well as cancer cells and objects such as wood splinte ...
to foreign materials in the human body. Medically, it occurs mostly in context of the complications from
breast implant A breast implant is a prosthesis used to change the size, shape, and contour of a person's breast. In reconstructive plastic surgery, breast implants can be placed to restore a natural looking breast following a mastectomy, to correct congenital ...
s and
artificial joint 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 an arthritic or dysfunctional j ...
prosthetics. The occurrence of capsular contraction follows the formation of capsules of tightly-woven
collagen Collagen () is the main structural protein in the extracellular matrix found in the body's various connective tissues. As the main component of connective tissue, it is the most abundant protein in mammals, making up from 25% to 35% of the whole ...
fibers, created by the
immune response An immune response is a reaction which occurs within an organism for the purpose of defending against foreign invaders. These invaders include a wide variety of different microorganisms including viruses, bacteria, parasites, and fungi which could ...
to the presence of foreign objects surgically installed to the human body, e.g. breast implants,
artificial pacemaker An artificial cardiac pacemaker (or artificial pacemaker, so as not to be confused with the natural cardiac pacemaker) or pacemaker is a medical device that generates electrical impulses delivered by electrodes to the chambers of the heart eith ...
s, orthopedic prostheses; biological protection by isolation and toleration. Capsular contracture occurs when the collagen-fiber capsule shrinks, tightens and compresses the breast implant, much like the collapse of a bubble gum bubble.Dr. Ted Eisenberg and Joyce K. Eisenberg, ‘’The Scoop on Breasts: A Plastic Surgeon Busts the Myths,’’ Incompra Press, 2012, It is a medical complication that can be painful and discomforting, and might distort the aesthetics of the breast implant and the breast. Although the cause of capsular contracture is unknown, factors common to its incidence include bacterial contamination, rupture of the breast-implant shell, leakage of the silicone-gel filling, and
hematoma A hematoma, also spelled haematoma, or blood suffusion is a localized bleeding outside of blood vessels, due to either disease or trauma including injury or surgery and may involve blood continuing to seep from broken capillary, capillaries. A he ...
. Moreover, because capsular contracture is a consequence of the immune system defending the patient's bodily integrity and health, it might recur, 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 use of macrotextured implants and polyurethene-coated implants may increase the risk of BIA-ALCL, a rare form of lymphoma associated to the presence of breast implants. 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 Ultrasound is sound waves with frequency, frequencies higher than the upper audible limit of human hearing range, hearing. Ultrasound is not different from "normal" (audible) sound in its physical properties, except that humans cannot hea ...
, treatment with
leukotriene Leukotrienes are a family of eicosanoid inflammatory mediators produced in leukocytes by the oxidation of arachidonic acid (AA) and the essential fatty acid eicosapentaenoic acid (EPA) by the enzyme arachidonate 5-lipoxygenase. Leukotrienes ...
pathway inhibitors (e.g. Accolate,
Singulair Montelukast, sold under the brand name Singulair among others, is a medication used in the maintenance treatment of asthma. It is generally less preferred for this use than inhaled corticosteroids. It is not useful for acute asthma attacks. ...
), and pulsed electromagnetic field therapy. Friday, 27 November 2020 The Mentor Worldwide LLC corporation, one of the three, U.S. FDA-approved breast-implant device manufacturers, conducted a study of the
medical complication A complication in medicine, or medical complication, is an unfavorable result of a disease, health condition, or treatment. Complications may adversely affect the prognosis, or outcome, of a disease. Complications generally involve a worsening in ...
s suffered by breast implantation surgery patients. In March 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 ''
FDA The United States Food and Drug Administration (FDA or US FDA) is a federal agency of the Department of Health and Human Services. The FDA is responsible for protecting and promoting public health through the control and supervision of food ...
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

Breast Augmentation Surgery Risk & Complications
Website - BreastAugmentation101


References

{{DEFAULTSORT:Capsular Contracture Plastic surgery Breast Implants (medicine)