Breast enlargement with silicone implants are very common. In medical terms it is called as “augmentation mammaplasty”. This procedure is very efficient, safe and reliable. But in some patients an unwanted situation may occur: Capsule formation.
Most of the silicone breast prosthesis are designed and produced for lifetime stay in the body. A silicone implant is made of an external shell and inner gel. External shell is very strong thin solid and elastic silicone sheet and filled up with a cohesive silicone gel with the same hardness of the natural breast. The outer silicone shell is very well tolerated by the body. After insertion into the breast silicone prosthesis can not be felt or detected by touching or squeezing the breasts by hand. But although rare in some situations body considers the silicone as a threat and takes action to isolate it. A fibrous protective lining is woven around the whole prosthesis. This extremely strong lining is mainly made of collagen fibers and called as fibrous capsule. If this capsule is soft and thin will not cause any symptoms and can stay forever around the implant. In this capsule gets thicker it hardens and can be felt inside the breast and my cause pain when touched. The capsule may also shrink and distort the shape of the prosthesis. This is called as capsular contracture. Capsule contracture squeezes the prosthesis resulting a stony hard mass into the breast and disfigures the appearance of the breast. Although it not a life threatening situation it may be very painful and unacceptable both aesthetically and socially.
The main cause of the capsule formation is the insufficient purification of the silicone. Medical grade silicone is very different from industrial grade silicone and much more expensive. If the breast prosthesis is not produced correctly then after the implantation the protective mechanism of the body recognize the unwanted material into the silicone and tries to imprison the whole prosthesis within a fibrous capsule. Only FDA (U.S. Food and Drug Administration) approved silicone prosthesis should be used for breast enlargement.
Another reason of the fibrous capsule is attachment of foreign bodies around the prosthesis like powder of the operation gloves or dusts of the surgical gauze or surgical dressings. To prevent this the prosthesis should be inserted into the breast after opening the package with minimum touch or no touch technique if possible.
Infection is another reason of capsule formation. Micro infections around the implants without any clinical symptoms may initiate fibrous capsule. Absolute sterility is utmost important in breast enlargement operations.
Despite all precautions capsule formation may still occur in a low percentage of the silicone breast enlargements without any detectable reason.
The treatment of the breast implant capsule depends of the severity of the symptoms and physical appearance. Thick and shrunk capsule accompanied by pain and breast distortion should be treated by operation. Prosthesis and fibrous capsule are both removed and than if the silicone prosthesis is undamaged and in good condition could be reinserted into the breast again. But most of the time prosthesis is also damaged and it is better to replace it by a new one. If capsular contracture is occurring again and again over the new prosthesis then the silicone implants should be removed and an alternative procedure like fat injection should be considered for breast augmentation.