Sometimes, complications arise during or after surgery, regardless of how skilled the plastic surgeon is. This is the case because each individual’s body is unique. For instance, the composition of connective tissue varies greatly from patient to patient, and as a result, each patient’s healing process is entirely unique. This explains why some individuals tend to develop thick scar tissue after any type of penetrating skin injury, while others can sustain deep cuts and develop only subtle scarring that fades with time. The fact that some women will develop severe stretch marks during pregnancy regardless of what they do to prevent them, whereas others will emerge from pregnancy nearly stretch mark-free, is a further illustration of this difference. In addition, the immune system of each individual reacts differently to stimuli, and some patients’ immune systems react poorly to medical implants.

Obviously, complications during plastic surgery are now extremely uncommon, due to both advances in surgical techniques and improved ability to predict which patients will experience surgical complications. Patients who are prone to developing thick scar tissue may be advised to avoid plastic surgery, or their surgeon will use special surgical techniques that allow incisions to be placed remotely (e.g., inserting breast implants through an incision in the underarm) to minimize scarring. Patients with compromised immune systems or autoimmunity are frequently advised to forego surgery in favor of less invasive cosmetic enhancement procedures. Similarly, a number of procedures, such as the Aspen Rehabilitation Technique, can be used after surgery to treat complications and improve the patient’s appearance. After breast augmentation, the treatment of capsular contracture is one of the most common applications of Aspen.

What is the definition of capsular contracture?
The formation of a scar tissue “capsule” around any implant (medical or cosmetic) is a normal part of the healing process. The body reacts automatically to any foreign object it detects within it and attempts to isolate it by forming a scar tissue barrier. In the case of breast implants, this is generally a good thing, as the capsule prevents the implants from slipping out of place. However, in some patients, this capsule of scar tissue becomes abnormally rigid and begins to contract around the implant. This can cause both aesthetic issues and, in extreme cases, breast pain. According to research, approximately one in six breast augmentation patients experience capsular contracture, though not all cases manifest obvious symptoms. Using a grading system, the severity of capsular contracture is determined:

Capsular contracture of grade 1 is asymptomatic (producing or showing no symptoms). The development of scar tissue around the implant has no effect on the size, shape, or texture of the breasts. The breasts appear natural and remain touchably soft.
Capsular contracture of grade 2 typically presents with only minor cosmetic symptoms. Typically, the breasts will have a normal appearance and feel somewhat firm to the touch.
Grade three capsular contracture is characterized by obvious cosmetic symptoms. The breasts will be firm to the touch and abnormal in appearance, for example, they will be excessively round and rigid, and the nipples may be misshapen. However, this degree of capsular contraction rarely (if ever) causes pain.
Similar to grade three capsular contracture, grade four causes breasts to become hard and misshapen. Patients with capsular contracture of grade four also experience breast pain; their breasts are frequently tender and painful to the touch.
Capsular contracture typically occurs during the healing process. Approximately 75% of all capsular contractures will occur within two years of implant placement. Occasionally, capsular contractures occur many years after breast augmentation surgery, but this is the exception. If this occurs, the breast implants of the patient should be examined for ruptures. Implant rupture is the most frequent cause of late-onset capsular contraction.

What causes capsular contracture?
There are a number of hypotheses among clinicians regarding the causes of capsular contracture, and it’s likely that the exact causes of this condition vary from patient to patient. As a breast augmentation patient, you must understand that this condition is not the result of breast implants being toxic or dangerous. Silicone gel implants are composed of medically inert silicone, whereas saline implants contain only saline solution, which can be reabsorbed by the body without causing harm. Indeed, capsular contracture can occur after the insertion of any type of medical implant; breast augmentation surgery is not an exception. Capsular contracture after breast augmentation is especially problematic because it frequently alters the appearance of the breasts, thereby jeopardizing the aesthetic enhancements that the patient underwent surgery to achieve. Unless the patient’s implants have ruptured, capsular contracture rarely poses a threat to her health (in the case of gel implants, rupture can sometimes lead to infection).

According to researchers, genetics play a role in determining who develops capsular contraction and who does not. You may have a slightly increased risk of developing this condition if you have a family history of autoimmune disease or if you have relatives who frequently develop thick scar tissue after injury (or who have had problems with medical implants). However, it is impossible to accurately predict who will and who will not develop a “random” case of capsular contracture (i.e., one that is not caused by any externally identifiable factors). Because capsular contracture is highly treatable, you should not let a fear of developing it prevent you from undergoing breast augmentation.

Sometimes, something other than the patient’s own body reacts negatively to the presence of breast implants, causing capsular contracture. In addition to implant ruptures, it is now believed that “biofilm” frequently contributes to this condition’s development. Biofilm is a thin layer of bacteria that forms around breast implants after a type of bacteria (typically staph bacteria) is introduced into the breast cavity during surgery. This bacterium causes a type of chronic, low-grade infection that may not manifest obvious symptoms (such as fever or severe fatigue). Nonetheless, as the body fights this infection, it produces an increasing amount of fibrous scar tissue, resulting in capsular contracture. A recent study conducted on pigs implanted with medical-grade silicone implants provides support for the biofilm theory of capsular contracture. This study demonstrated that pigs with staph bacteria on their skin at the time of implant placement were significantly more likely to develop capsular contracture. It is important to note that staph contamination during breast augmentation surgery is not necessarily the result of an unhygienic workplace. Some individuals are natural carriers of the staph bacteria; it is always present on their skin and rarely causes symptoms. This bacterium has the potential to cause serious problems only when the skin of these individuals has been breached. Although maintaining a clean workplace can help reduce the risk of staph contamination, it is not always possible to eliminate all of the bacteria that are present.

Other uncommon complications of breast augmentation surgery, such as hematomas and seromas (blood clots that occasionally form after invasive surgery), may also increase the risk of capsular contracture. Some researchers believe that these blood clots increase the likelihood of capsular contracture by providing an abundant source of nutrients (in the form of blood) to bacteria, thereby promoting the growth of biofilm. How can this condition be prevented?

Although it is impossible to prevent capsular contracture in every patient, there are several ways to reduce the risk of a patient developing this condition. In order to accomplish this, plastic surgeons now employ the following preventative measures:

Patients are thoroughly screened for health conditions that may increase their risk of complications such as hematomas. Patients are also required to quit smoking, as smoking increases the likelihood of hematoma formation and impairs healing in general.
Using the appropriate implant size for the patient: When a patient has insufficient natural breast tissue to cover a large implant, the risk of capsular contracture increases. If a patient with small breasts wants to significantly increase her cup size, it is best to do so in stages, e.g., begin with a medium-sized implant and allow the skin to stretch before placing a larger one.
Minimal implant handling: The greater the number of times an implant is handled prior to insertion into a patient’s breast, the greater the likelihood of bacterial contamination. As a result, surgeons limit their contact with implants prior to insertion into a patient’s body. Additionally, board-certified plastic surgeons work in a sterile hospital environment.
It has been demonstrated that using gel implants with a textured surface, as opposed to a smooth surface, reduces the likelihood of capsular contraction. It is believed that the textured surface of the implant hinders the formation of dense scar tissue around the implant. However, textured implants are not ideal for every patient, as their edges may be more noticeable in some cases. Typically, they are most suitable for use when placing implants beneath the chest muscles.
The use of “under the muscle” placement can substantially reduce the risk of capsular contracture. Over the muscle implant placement carries a 12-18% lifetime risk of capsular contracture, whereas partial under the muscle implant placement carries an 8-12% lifetime risk. Moreover, implants placed completely under the muscle are associated with a 4-8% risk of capsular contracture over the course of a lifetime.
Massage: Massaging the breasts while they are healing from breast augmentation surgery may prevent capsular contracture by encouraging the breast tissue to remain flexible. However, no major studies have demonstrated the effectiveness of this strategy. While your breasts are healing from surgery, you should never disturb the tissue without your surgeon’s permission. Otherwise, you risk damaging the tissue and increasing the likelihood of capsular contracture.
How does Aspen reverse and treat capsular contracture?
The available treatment options for breast augmentation patients with capsular contracture left much to be desired in the past. Frequently, revision surgery was necessary, a lengthy, costly, and unpleasant solution. During this procedure, the patient’s implants were removed, she was treated with antibiotics, and (once the infection had subsided) she was given the option to have breast implants reinserted. Due to the fact that this surgical procedure leaves the body susceptible to a second bacterial invasion, many of these patients experienced recurrent cases of capsular contracture.

Multi-energy therapy from Aspen is unique. It is completely noninvasive, so it does not cause pain or inconvenience to the patient, nor does it increase her future risk of developing capsular contracture. During Aspen therapy, without making incisions, a special device (the Aspen harmonizer) is applied to the patient’s breast tissue. The Aspen harmonizer transmits precisely controlled ultrasound waves to the patient’s tissue, thereby promoting the development of healthy collagen. This increases the elasticity of the breast capsule surrounding the implant, restoring the breasts’ softness and pliability. In addition, it has been demonstrated that the ultrasound waves used in Aspen therapy enhance the effectiveness of antibiotics against biofilm. Typically, Aspen therapy is administered over a period of two to three weeks in conjunction with antibiotic therapy to treat the underlying cause of capsular contracture. For grades two and three of capsular contracture, the Aspen method has been demonstrated to be effective. Cases of grade four may necessitate more aggressive surgical intervention.