Capsular fibrosis is a complication that can occur with breast augmentation. It involves the formation of a hard tissue capsule around the breast implant due to a natural but excessive immune response of the body. Improved implants and gentler surgical techniques can significantly reduce the risk of capsular fibrosis.
What is capsular fibrosis?
Cross-section of a breast with silicone implant after breast augmentation. Capsular fibrosis can occur in this area. Capsular fibrosis refers to the formation of a hard shell that surrounds a breast implant. It consists of a layer of connective tissue that forms around any foreign body in human tissue as part of normal immune defense. When this layer thickens and hardens unnaturally, it can result in severe pain as well as hardening of the breast. Visible deformities may also occur. In addition, if capsular fibrosis occurs, there is a risk that the implant will rupture.
Causes
The cause of the development of capsular fibrosis is still unknown. The development of a thin enveloping layer of connective tissue is a regular reaction of the body to foreign material. This serves as a barrier between healthy tissue and potentially harmful substances. Why this connective tissue layer loses its elasticity and increases in thickness in some cases has not yet been determined. However, there seem to be some factors that favor the development of capsular fibrosis. These include the use of smooth-walled breast implants, in which capsular fibrosis occurs in up to 30 percent of cases after breast augmentation. The type of surgery also appears to have an influence. For example, capsular fibrosis occurs significantly more often when the implant is placed above the pectoral muscle than when it is placed in a pocket under the pectoral muscle.
Symptoms, complaints and signs
Capsular fibrosis can be almost asymptomatic. However, the disease usually causes severe pain and visible changes in the breast area. In the first stage of the disease, the breast is only slightly indurated and there are usually no symptoms or discomfort. Those affected occasionally feel a slight discomfort, but this usually subsides. In the second stage, the capsular fibrosis causes a noticeable feeling of tension in the breast, accompanied by pain and a growing feeling of discomfort. In the third stage, the hardening can be detected externally. The feeling of tension increases and the pain intensifies. Furthermore, at this stage there may be circulatory disturbances and overheating of the breast. In the fourth and final stage, the breast has already become severely deformed and is extremely sensitive to touch. Hardening can be detected externally. In addition, inflammation can develop, which further intensifies the signs of the disease and often leads to fever. The symptoms can lead to secondary symptoms such as sleep problems or psychological problems. Affected persons are often irritable, tired or in a bad mood as a result. The symptoms of capsular fibrosis develop gradually and subside with early treatment.
Diagnosis and course
Capsular fibrosis can go almost unnoticed, but it can also lead to severe pain and visible changes in the breast. Four stages of capsular fibrosis are distinguished. In stage 1, the breast is only very slightly hardened and there is no or only extremely mild discomfort. The diagnosis is made by palpation and ultrasound. This also applies to stage 2, in which the capsular fibrosis can already cause slight pain and a feeling of tension in the breast. In stage 3, capsular fibrosis can already be diagnosed by external appearance, as the hardening of the connective tissue envelope leads to visible changes in the breast. In addition, severe pain may occur. When capsular fibrosis has reached stage 4, the entire breast is hard, deformed and extremely sensitive to touch. Whether capsular fibrosis is related to silicone disease after breast implantation has not yet been scientifically clarified.
Complications
Capsular fibrosis occurs mainly when the patient has breast augmentation. This can lead to various complications and discomforts after the operation. Most of those affected suffer from severe pain that occurs in the breast.This pain can spread to other regions of the body. It is not uncommon for pain at rest to lead to difficulty sleeping at night and can thus significantly reduce the patient’s quality of life. The breasts are also tense. It is not uncommon for the implants themselves to slip, which can also lead to aesthetic complaints. Many of those affected also suffer from reduced self-esteem and are ashamed of the appearance of the breasts. These often appear asymmetrical and show wrinkles. Treatment of capsular fibrosis is usually symptomatic. If there is only pain, this can be limited with the help of medication. Possible inflammations are also limited with the help of medication. If the symptoms are severe or result in a greatly reduced appearance, further surgical interventions are necessary in most cases. In most cases, this does not lead to complications. Capsular fibrosis does not lead to a reduction in life expectancy.
When should you go to the doctor?
Women who have undergone breast augmentation should have the breast implant checked by a medical professional at regular intervals. If abnormalities or peculiarities appear, a visit to the doctor is necessary to clarify the circumstances. If there is any hardening in the immediate vicinity of the implant, special care should be taken. Therefore, the breast should be palpated several times a month on one’s own responsibility. As soon as lumps or swellings are noticed, a doctor should be consulted immediately so that a diagnosis can be made using imaging procedures. If there is pain or a feeling of tightness in the breast, a visit to the doctor should be made. If any irregularities are noticed during rotation or locomotion, it should be reported to a physician. The pain indicates an inconsistency that should be urgently investigated. Sudden and untraceable deformities of the breast or displacement of the implant are warning signs that should be checked by a physician. A feeling of twisting or palpable structural changes of the implant, must be clarified by a specialist. Since damage to the implant can have serious health consequences, a doctor should be consulted as soon as possible. Wrinkling of the breast is also considered unusual and should be examined more closely. If the discomfort continuously increases in intensity, a doctor is needed.
Treatment and therapy
Stage 1 capsular fibrosis usually does not require treatment. If pain occurs, drug therapy with anti-inflammatory agents may be prescribed. In the case of mild discomfort, massage or ultrasound treatment can also provide relief. From stage 3, surgical treatment is unavoidable in the case of capsular fibrosis. Depending on the severity, loosening, blasting or removal of the connective tissue capsule may be considered. If capsular fibrosis is already very advanced, removal of the entire breast implant may be necessary.
Outlook and prognosis
Capsular fibrosis does not necessarily require medical treatment. Rather, it usually heals without complications and can be promoted here by hot baths and also massages. These stimulate blood circulation and thus promote the body’s self-healing process. If there is no improvement after a few days or if pain occurs, a medical consultation is inevitable. Depending on the severity, he or she may advise acupuncture or Chinese medicine treatment and support this with anti-inflammatory and pain-relieving medication. In the worst case, however, surgical capsule removal is necessary. Whether this is actually necessary in individual cases depends on the existing pain of the affected person. Affected persons should inform the doctor of all medications taken before surgery in order to prevent possible interactions with anesthetic medications. After the operation, rest and meticulous personal hygiene are indicated in order to avoid complications such as wound healing disorders or infections. Under certain circumstances, a change in diet can even be helpful, which the doctor will be happy to assist with in cooperation with a nutritionist. The body needs sufficient proteins, carbohydrates, fats, vitamins, minerals and trace elements to fight off pathogens and build up new skin. The better the body is supplied with these nutrients, the less painful the wound healing process will be.A good supply of oxygen through plenty of fresh air is equally beneficial.
Prevention
Various measures can be taken to prevent capsular fibrosis. In particular, when choosing a breast implant, emphasis should be placed on a coarsely textured surface, as this reduces the risk of capsular fibrosis to less than five percent. Placing the implant below rather than above the pectoral muscle also significantly reduces the risk. Particularly gentle surgical techniques can also prevent subsequent capsular fibrosis. These include avoiding contact of the implant with the skin, the use of drains during and after surgery, and surrounding the implant with antibiotics. This can be further supported by continuing antibiotic prophylaxis in the first weeks after surgery. During this time, a stable compression bra should also be worn to ensure that the implant remains in its intended location and bonds well with the surrounding tissue. If all these precautions are taken into account, the occurrence of capsular fibrosis is very unlikely today compared to earlier breast implants.
Aftercare
In most cases of capsular fibrosis, there are no or few measures of direct aftercare available to the affected individual. Therefore, those affected by this disease should see a doctor at a very early stage so that there is no further worsening of the symptoms. As a rule, self-healing cannot occur. As a rule, early diagnosis can always have a positive effect on the further course of the disease. The treatment of capsular fibrosis is usually carried out by taking various medications. The patient should always ensure that the medication is taken regularly and in the correct dosage. In case of any uncertainties or questions, a doctor should always be contacted first. In severe cases, capsular fibrosis can also be treated by surgery. In this case, the patient should always rest and take care of his body after the operation. The patient should refrain from exertion or other physical and stressful activities. Support and help from friends and family can also have a positive effect on the further course of capsular fibrosis. As a rule, the disease does not reduce the life expectancy of the affected person.
What you can do yourself
Capsular fibrosis does not necessarily require medical treatment. In most cases, it does not cause complications and in many cases resolves itself. However, if pain occurs, medical evaluation is indicated. The patient can support the medical therapy with various self-help measures. For example, massages or hot baths have proven effective. In consultation with the physician, alternative treatment methods such as acupuncture can be tried. Chinese medicine also offers alternative measures that can dissolve capsular fibrosis. If the symptoms are more severe, the hardening must be operated on. After an operation, bed rest and rest and recuperation initially apply. The patient may also have to change his or her diet to ensure that the surgical wound heals without symptoms. This is accompanied by close medical monitoring. Various complications can occur, especially after the removal of advanced capsular fibrosis, and these must be treated at an early stage. The affected person must also ensure adequate personal hygiene to avoid wound healing disorders, infections and similar complaints. If, despite these measures, signs of a severe course or serious complications become apparent, the physician must be consulted promptly.
