I am considering getting breast implants, but I'm very worried developing capsular contracture. Have there been any studies about the likelihood of this possible side effect? Are there any predispositions or behaviors that would make a patient more likely to develop CC after surgery? I'm trying to determine whether the risk would be acceptable. Thank you for your help.
How Likely is It to Develop Capsular Contracture?
Doctor Answers 10
Breast Implants and Capsular Contracture
There is not way to predict who will develop a capsule contracture postop. It is not common. Please read the advice given below by my colleagues. There are a number of things you can do to help prevent a capsule and speed your recovery. After your surgery, there are three very important things to do. The ﬁrst is getting your arms over your head. You should begin to do this six to eight hours after surgery. Do a set of three arm raises every hour before going to bed. The worst thing a marathoner can do after a race is to lie around doing nothing. Instead, stretching and walking help the muscles to recover more rapidly. The same principle holds true for the quick recovery method. You may lift objects that weigh less than 30 pounds and drive a car if you’re oﬀ prescription pain medication.
The second is actually a don’t: Don’t baby your breasts. You can’t hurt or rupture your implants or rip open your stitches, a common but unnecessary fear, by going about your daily routine. Look at your breasts in a mirror. Touch them, and get to know them. They’re not the same as what you’ve been used to all these years and they are going to feel weird for a while, so it’s important to become familiar with them.
Finally, lie on your breasts—yes, that’s right—for 15 minutes every day starting the evening of your surgery. Plan on doing this every day after surgery for one year. You will feel better and lessen the risk of developing scar tissue around the implant, which almost always occurs within one year. All the best! "Dr. Joe"
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Risk of Capsular Contracture After Breast Augmentation
Retrospective and noncontrolled studies of single surgeon series is about 2-3% in a 3 year period of subpectorally placed implants. The risk increases over time. There are no new studies and the ones that mention 10% were from the old silicone implants that "bleed" meaning there is a greasy effluent coming from the implant. The new implants do not have that problem and the shells are much better. Also, placement under the muscle has drastically reduced the occurrence of capsular contracture. In the future, I believe it will be excedingly rare to hear of capsular contracture. New studies are being done to look at bacteria as the cause and some studies show that washing the breast pocket with antibiotic solution prior to placing the implant can reduce the incidence.
Risk of capsular contracture
Capsular contracture is a significant complication of breast augmentation. There are many theories as to why this occurs. The most likely contributing factors are:
1) low grade infection (usually without other signs of infection such as fever, drainage or redness)
2) hematoma (bleeding after surgery around the implant)
Preventing capsular contracture at the time of surgery
Each surgeon has their own breast augmentation protocols to help prevent this complication. I give every breast augmentation patient antibiotics just before surgery and oral antibiotics after surgery. I also use an antibiotic solution to rinse around the implant and in the implant pocket before the implant is placed. Accurate hemostasis is used to prevent small or large volume bleeding around an implant.
Submuscular implants have a lower risk. Saline implants have a slightly lower risk than silicone. Theoretically, a periareolar incision (bacteria in milk ducts) has a higher CC risk.
There are a few theoretical measures that may help improve capsular contracture including implant massage, Vitamin E (oral), and smoking cessation.
I have been fortunate to have a very low CC rate (2-3%) by consideration of the above factors. Hopefully with a better understanding of CC we can eliminate this as a risk factor.
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Issue of capsular contracture
The relative rate of capsular contracture has been quoted at various percentages due to implant variables particularly with regard to changes in silicone implants but it does appear to be at 10% or less. There are surgical techniques which can potentially lower the risk which will never be zero, however. An incision at the inframammary fold has been shown to have a lower incidence of subsequent capsular contracture developing as compared to the peri-areolar or transaxillary approaches.
There have been many studies looking at capsule contracture as the previous responders have alluded to. I always tell my patients that there is about a 15% chance in their lifetime. In my own personal practice I have about a 2% incidence over the 15 years that I have been in practice with the majority of these occurring in the first year. The majority of my implants have been placed through a periareolar incision. Using electrocautery dissection to minimize bleeding, submuscular placement, antibacterial irrigation and early massage I believe all contribute to a low rate. Even if you were unlucky and got a capsule, the vast majority of the time it can be taken care of with a simple open capsulotomy procedure.
Capsular contracture is the most frequent complication of breast aug.
The rate of capsular contracture has been studied and various estimates are to be found in the literature. The risk increase with time. By ten years after surgery, the risk may be 10 percent or so. This is pretty high. And surgeons don't know why it happens. But we do know that using implants below the muscle helps. In the past, saline implants have had an advantage, but this is probably not the case with the new silicone implants. The good news is that a capsular contracture may be treated with an open capsulotomy, which is not particularly painful and the recovery time is short. It is also highly effective and usually the problem does not return, although there are exceptions. So yes, you are correct to be concerned, but the problem is usually effectively treated if it happens. I talke more about this on my website.
Studies about capsular contracture
The incidence and cause of capsular contracture has been very well studied, though the exact causes are elusive. We do know that with 'best practices' the overall capsular contracture rate is 5-6% for silicone gel, and perhaps half that rate for saline implants. Capsule rates are also reduced with a submuscular pocket, and a transaxillary insertion. Over many years the capsule rate will creep up for gel, probably due to bleed and leak. Many surgeons have a technique or a 'ritual' if unproven to keep the rates as low as possible, still they happen. We have found that most breast implant patients will not give up the implants despite the capsule.
Best of luck, peterejohnsonmd.com
There is always a risk for a capsular contracture to develop. Reports are in the range of 5-10% in a 3 yr period. It is unclear exactly why they develop.
Risk of Breast Implant Capsular Contracture
The risk of capsular contracture depends on a few things. It is much higher in breast reconstruction than breast augmentation. Patients who had it once, seem more likely to develop in again.
Based on the large studies by Mentor and Allergan (the 2 main implant manufacturers in the USA), the rates of Baker Grade 3 or 4 capsular contracture for primary breast augmentation are:
Allergan 16% at 7 years
Mentor 8% at 3 years
There aren't any proved patient patient predispositions to capsular contracture.
Risks of capsular contracture
All implant patients take on the risks of capsular contracture. The risks can be lowered by proper surgical technique and there are many recent answers on RS about that. The risk will never be zero, but salines are lower than gels in my experience and below the muscle is best too. The national risk is between 5-9 percent approximately so more than 90-95% do well with no capsular contracture. No specific risks are known other than the one that exists when a previous CC patient has a revision, the risk of repeat CC is at least 20%.