Why do some patients experience hardening in their breasts after implants

The main problem with breast implants is capsular tightening and hardening. When you have anything foreign in your body, whether it is a splinter, an artificial joint, a pacemaker or a breast implant, your body forms a scar -called a ‘capsule’ around it. These are your cells and they form a thin membrane around the foreign object. This membrane then can tighten – it is actually trying to do a good job – getting rid of what doesn’t belong. You may know of someone who has had bits of glass come out of their skin years after a car accident. Capsule formation is an appropriate process under normal circumstances – it’s just with breast implants it can then make them feel hard and distorted. The implants themselves don’t actually “go hard” – it is the tightening of the capsule that makes them feel hard and often gives them a distorted shape.

How many patients develop breast capsules? Everyone. How many get capsules that are firm ? – probably about 6%, but many patients actually like some firmness. How many want to do something about the firmness? Probably about 3%, with only about 1% or less ever wanting the implants out completely.

If we could predict who would develop capsular contracture, if we knew how to prevent it, or if we could always successfully treat capsules, then breast augmentation would be an excellent procedure and there would be very little controversy surrounding it.

We cannot predict who will get capsular hardening. But we do believe that there are some things that can be done do to prevent them from forming. If you have a rough surfaced ‘textured’ implant- this roughness will help to prevent tightening of the capsule. If you have a smooth surfaced implant, we ask you to perform exercises where you stretch the capsule on a twice-daily basis for the first 5 months, and daily there-after. Hamish will show you how to do this if you have smooth implants.

If you develop a hard capsule that bothers you, the next step is to re-operate, surgically release the capsule and hope (with aggressive exercises) that the capsule will not tighten again.

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