The body forms a breast capsule around a breast implant as a reaction to the foreign body. Normally, the capsule is thin and does not cause any discomfort. The breast feels soft and mobile.
Excessive capsule formation is referred to as capsular fibrosis or capsular contracture. The thickened capsule compresses the implant, changes the shape of the breast and can cause pain.
What are the risks of breast implants?
As with any medical product, there are also risks associated with breast implants. The most common complications are revision surgery, capsular fibrosis, implant removal and ruptures.
Capsular fibrosis
Once the breast implant has been inserted, the breast tissue normally forms an internal scar around the implant, which acts as a capsule and holds the implant in place. In some women, however, this capsule formation causes the tissue to compress the implant, which is known as capsular fibrosis.
How does capsular fibrosis develop in breast implants?
Capsular fibrosis in breast implants can be promoted by various factors. There is an increased risk if there is a haematoma or infection after the operation. In addition, the risk is increased if the breast augmentation is accessed via the atrium due to the increased risk of infection.
The placement of the implant also plays a role. If the implant is placed above the muscle, the risk of capsular fibrosis is higher than if it is placed below the muscle. The coating of the implant is also relevant. Implants with a rough surface have a lower risk of capsular fibrosis compared to smooth-walled implants.
When do the implants have to be removed in the case of capsular fibrosis?
Capsular fibrosis is classified according to Baker.
- Baker I: A soft capsule surrounds the implant, no changes detectable.
- Baker II: Slight hardening of the connective tissue, possible feelings of tension.
- Baker III: Moderate hardening of the connective tissue, incipient deformation of the implant.
- Baker IV: Shrinkage of the connective tissue around the implant, severe pain and significant deformation of the breast.
If the implant is under the muscle, the risk of capsular fibrosis after 10 years is around 10%. Treatment should be considered at the latest at Baker III-IV staging. prosthesis removal is recommended.
Does the health insurance cover the costs?
The costs of removing the prosthesis and capsule are covered by the health insurance company, less the annual deductible and excess. An application for approval of costs must be submitted to the relevant health insurance fund beforehand. A corresponding application for approval of costs must be submitted to the relevant health insurance fund beforehand.
What options are there after denture removal and what is my cost share?
You have various options after the prosthesis removal. You can do without further breast implants, which does not incur any additional costs. The aesthetic result depends on the skin elasticity and breast size.
Other options include breast lift, breast reduction, breast augmentation with autologous fat and/or implants. These options are discussed in an individual consultation. These operations are not usually covered by health insurance and are at the patient’s expense. You will receive a detailed cost estimate based on the additional procedures and the duration of the operation.
Does the whole capsule have to be removed?
The capsule is usually removed completely if the implant lies over the muscle, if BIA-ALCL is suspected or if there is significant thickening of the breast capsule.
Can I prevent capsular fibrosis?
The risk of capsular fibrosis can be minimized by choosing a smooth-walled implant, placing it under the muscle and accessing it via the underbust crease or armpit. Nicotine consumption is also a risk factor for capsular fibrosis.
If you have already had capsular fibrosis, taking an anti-inflammatory medication (leukotriene antagonist) or preventive ultrasound treatments after the prosthesis change can further reduce the risk. Regular implant massages can also minimize the risk of capsular thickening.
What are the risks, what is the procedure like and what do I have to keep in mind after the operation?
The operation is usually performed under general anesthesia and requires a hospital stay of two to three days. Wound drainage tubes are often used and can usually be removed after 24 hours. Manual lymphatic drainage (10-15 sessions, twice a week) supports wound healing.
After the operation, ultrasound treatments can be performed or leukotriene inhibitors can be taken for 90 days to reduce the risk of capsular fibrosis recurring. The risks and behavioral measures after the operation are similar to those for breast augmentation, breast reduction or breast lift.