Plastic Surgery Research Manchester - Scars

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The commonest complication of breast implant surgery is capsular contracture formation. Placement of any implant in the body provokes a foreign body tissue reaction, an important component of which is the formation of an enclosing capsule of fibrous scar tissue around the implant. Capsular contracture occurs when the scar tissue (capsule) that normally surrounds an implant contracts and squeezes it. Symptoms range from mild discomfort and firmness, to severe pain, palpability, distorted shape and/or movement of the implant. Capsular contracture impairs the achievement of expected and desirable results and can lead to considerable distress and reduced quality of life. In addition, further medical interventions may be necessary which pose additional health risks for patients. The aetiology of capsular contracture is poorly understood and current literature provides conflicting results. Certain conditions are thought to increase the incidence such as haematoma, silicone leakage, infection, radiation and implant mobility. Incidence and severity of contracture increase with both implant duration and patient age. In particular, the incidence of contracture is far higher in patients who undergo implant surgery following mastectomy for breast cancer, in comparison to augmentation procedures for cosmetic reasons. Certain women are thought to exhibit a genetic predisposition to capsule contracture formation which, through interaction with various environmental factors may lead to increased rates and severity of contracture. Further understanding of the aetiology of capsular contracture may enable surgeons to screen women before they undergo breast implant surgery to detect those who are at greater risk of this complication; thus allowing patients to make fully informed decisions regarding their individual post-operative risk. An understanding of the pathogenesis of contracture may make it possible in the future to modify the physical / chemical structure of implants or recommend alternative methods of breast reconstruction / augmentation.

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