After breast cancer surgery, many women opt for breast implants. There are pros and cons of breast implants–both physical and psychological. The most common physical risk, occurring in about 10% of cases, is scarring called “capsular contracture.”
What is Capsular Contracture?
The body forms fibrous scar tissue around any foreign object in its tissues. This “bubble” of scar tissue is called the “capsule” and–normally–is relatively thin and soft. In the case of breast reconstruction, the capsule is beneficial, as it keeps the implant in place. In some instances, though, the capsule thickens, hardens, and contracts. The results can be tightness, pain, and visible distortion of the implant.
The precise causes of capsulitis are not certain, but one review of studies found that “Risk factors … included the use of smooth (vs. textured) implants, a subglandular (vs. submuscular) placement, use of a silicone (vs. saline) filled implant and previous radiotherapy to the breast” (PubMed). Infection at the surgery site can also contribute to this excessive scarring.
There are corrective surgery options for capsular contracture, but physical therapy can also be effective to reduce the pain and tightness.
Conditions Similar to Capsular Contracture
The shoulder area is intricate, and damage to it can create undesirable symptoms which are nuanced depending on the precise cause and location of the trauma.
Other conditions that are similar to capsular contracture include adhesive capsulitis, radiation fibrosis, and cording. These conditions are all technically distinct, but they have similar causes, symptoms, and treatments.
The following table breaks it down.
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|Materials and placement of a breast implant; infection.
|Site of breast implant(s)
|Tightness, pain, distortion
|Physical therapy, early and often
|Adhesive capsulitis (a.k.a. “frozen shoulder”)
|Shoulder trauma such as mastectomy, esp. with significant lymph node removal
|Shoulder joint & surrounding tissues
|Tightness, pain, reduced range of shoulder motion
|Physical therapy, early and often
|Site of radiotherapy
|Inflammation leading to excessive fibrous scar tissue formation
|Appropriate dietary antioxidants; physical therapy
|Axillary Web Syndrome (a.k.a. “cording”)
|Inflammation resulting from surgery or other trauma
|Armpit; underside of the arm
|Taut, ropelike “cords” in the underarm area, perhaps running down to the elbow or further.
|Physical Therapy, early and often; anti-inflammatory diet
While there are treatments for each of these conditions, the best ways to avoid these problems are regular physical therapy under the supervision of an expert and a diet that minimizes inflammation.
Preventing Scar Tissue
We can all agree that prevention is better than treatment, and that are methods to prevent the scar tissue from forming in the first place:
- Expert application of ultrasound therapy, along with dietary sources of bioavailable collagen (e.g. bone broth) and Vitamin C, can also help the body to build back soft, flexible, vessel-rich tissues instead of hardened scar tissue.
- A diet rich in varied antioxidants and wholesome fats will also reduce inflammation and work against scarring.
- Certain steroids and other anti-inflammatory drugs have helped reduce/reverse capsular contracture, but these come with their own set of side effects and are not a good first option.
The results from a number of studies of non-surgical approaches basically demonstrate that it is best to take a multi-pronged approach and not rely on one single method. And start early.
Treatments for Capsular Contracture
Corrective surgical options involve entirely removing both the capsule and implant (perhaps installing a new implant, perhaps not), cutting open the capsule without disturbing the implant, or full breast reconstruction. Surgery may be a standard method to treat capsular contracture, and surgery may be the only viable option in severe cases of capsular contracture, but obviously avoiding it is preferable!
One non-surgical option is “closed capsulotomy”–essentially, applying a lot of pressure to break up the scar capsule. The contracture may or may not recur–it’s about 50/50. Implant manufacturers advise against this (due to the risk of rupturing the implant), but several studies consider it a worthwhile option, especially since complications are rare.
If scarring or tightness is already occurring, regenerative healing requires the right building blocks (nutrients), and also the right conditions. Physical therapy helps provide the right conditions for your body to rebuild.
Self-massage is recognized as beneficial therapy for preventing or treating capsular contracture, and your physician may recommend it (after initial healing has taken place). However, working with an experienced oncology physical therapist is also recommended since she can perform techniques you cannot, evaluate your progress more objectively, and precisely advise you on what methods would be most effective at each stage in the healing process.
If possible, set an initial “baseline” appointment with a PT prior to any surgery or radiation for breast cancer. Then follow up with your therapist as soon as possible during or after treatment. Early intervention can prevent many forms of scarring, toughening, and tightening (as well as lymphedema and related conditions). This can entirely eliminate the need for invasive revision surgeries or the riskier non-invasive methods later on
If you are experiencing symptoms of capsular contracture or just hope to avoid it entirely, please schedule a free 15-minute consultation with us to discuss your situation.