AESTHETIC MEDICINE AND SURGERY
Mammary implants are made of a silicone shell with a soft silicone gel inside. Modern medical silicone is a biocompatible, well tolerated material. The gel inside has good structural integrity and does not behave like a liquid; in the unlikely event that the shell is ruptured, the cohesive silicone tends to remain inside.
Shortly after breast implants are inserted, a fibrous film starts to form around their surface: a normal physiological process. This process, peri-prosthetic capsule formation, plays a major role in separating the implant from the surrounding tissues. At the same time it contributes to fix the implant in position, avoiding dislocation. If the implant ruptures, a rare event, the fibrous capsule acts as a partition between the silicone gel and the surrounding tissues.
Unfortunately, at times, the peri-prosthetic capsule becomes thicker than normal, contracting in such a way as to change the softness and shape of the breast. The cause of this is generally unclear; it has been demonstrated in some cases that contracture can occur after complications, such as bleeding or infection. If capsular contracture is of a higher grade (there are four grades), breasts can become hardened and misshapen, causing discomfort and pain.
In the 80s the incidence of capsular contracture was higher than 25%. Modern implants, which have a specially designed coating designed to prevent capsular formation, allow a significant reduction in risk to 2% or less.
It must be noted, in cases of minor contracture, there are no aesthetic changes or discomfort (grades I and II). When peri-prosthetic capsular contracture is severe, surgery is needed and consists of incision and/or removal of fibrous tissue and replacing implants on occasion.