I just returned from a Scientific Summit hosted by Mentor, which is the main breast implant manufacturer in my opinion. The subject of capsular contracture was discussed in detail, and the foremost scientific mind in the world was there.

He is a scientist who has studied this problem more than anyone else in the world. He presented some fascinating findings.

First, he described a biofilm, which is a term to mean an attachment of one or more colonies of bacteria on a surface. Surprisingly bacteria have a social life and communicate via quorum sensing chemicals. When they settle on a surface of anything they are very hard to eradicate.

They might settle on the surface of a breast implant or the scar capsule.

There are probably multiple causes of capsular contracture and biofilm is probably one of them. The research is exciting. It is promising, but it is frustratingly slow.

Bacteria have two states. One is the planktonic state where they float around in fluids or even gases. The other state is when they attach themselves to a surface. When we take a culture, we are sampling the planktonic state usually. When they attach themselves to a surface they are attached stronger than superglue, and they cannot be dislodged with a culture stick.

They pile up on top of each other in the biofilm and if we add antibiotics the antibiotic cannot penetrate. The outer surface bacteria might be killed off, but the deeper ones survive and multiply.

The biofilm is well organized with the same type of bacteria living together and with spaces within the colonies for fluid to flow. The body fluid contains protein, which is their nutrient and keeps them alive.

More later …

Scar capsule can shrink. Since we do not know why, the least we can do is to observe exactly what happens.

The capsule may shrink at any time. It might happen just months after the breast implant procedure was done, and it can also happen many years after the breast augmentation was done. It can happen at any time.

The capsule may shrink in one breast or both. Obviously if it occurs on one side only then the breasts will become different.

The capsule may not shrink evenly or uniformly. By this I mean that parts of the capsule might shrink only. If the lower part shrinks, it will squeeze the breast implant upwards and cause displacement. This means that the affected breast implant will be too high and cause an unnatural bulge in the upper chest on the affected side. Sometimes, the patient thinks the breast is growing bigger. This is because she is either looking down at the bulge as it goes higher or she sees it in the mirror. Actually, it is not growing. The breast implant is just moving upwards.

We must first analyze what has happened before we can decide on the most appropriate treatment or management.

Next week lets think about what might cause capsular contracture and how frequently if occurs. In subsequent blog episodes I will also explore what our current thoughts are for treatment or management of capsular contracture around breast implants.

If you have capsular contracture please comment and add your thoughts to this blog.