How much more of a risk of capsular contracture is there with implants above the muscle?

Dear A7183790,
capsular contracture happens. In fact, every implant has a capsule form around it, its just a certain percentage develop thick capsules. There is a lot we don't know about it actually. Some think that bacteria that gets on the implant during insertion can increase the risk. Thats why we use a Keller Funnel in our practice to reduce that possibility. Our capsular contracture rate is less than 2% because we use a keller funnel as well as meticulous operating room techniques.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

When it comes to breast augmentation, the risk of capsular contracture can vary depending on whether the implants are placed above (subglandular) or below (submuscular) the pectoralis muscle. Generally, implants placed above the muscle carry a slightly higher risk of capsular contracture compared to those placed beneath the muscle. The risk for subglandular placement tends to range from 10-15%, while for submuscular placement, it's typically around 5-10% (statistics vary among studies and implant types and surgical technique).
The muscle's additional tissue coverage in submuscular placement helps reduce inflammation and tension (factors that can contribute to capsular contracture). However, with advancements in implant technology and surgical techniques, the risk for subglandular implants has significantly decreased. Factors such as implant surface texture (smooth versus textured), surgical technique, and post-surgical care also influence the likelihood of developing capsular contracture. While submuscular placement may be recommended for minimizing this risk, many patients with enough breast tissue opt for subglandular or subfascial implants, as long as they follow proper aftercare to reduce complications. Discuss your preferences and concerns with your surgeon to make an informed decision tailored to your anatomy and aesthetic goals.
Krishna Vyas, MD, PhD, MHSHarvard, Hopkins, & Mayo Clinic Trained Aesthetic Plastic SurgeonNew York, New York

While it is generally accepted that capsular contracture rates for breast implants put underneath the breast is in the range of 10 to 15% and capsular contractor rates for implants placed underneath the pectoral muscle is 2 to 8%, there have been some studies, showing capsular`contrature rates of 1-2% for implants placed underneath the breast. These low rates are achieved using a 14 step protocol for skin, cleaning, pocket irrigation, and a no touch technique for the implants utilizing a sterile introduction sleeve for placing the implant. Discuss this with your plastic surgeon to see if they follow these protocols. One other option is the possibility of a sub fascial breast augmentation, where the implant is placed underneath the pectoral fascia, but above the muscle. This introduces an additional layer of protection between the breast and the implant and also carries a very low capsular contraction rate.

Thanks for your question, which is a good one. All breast implants will form a capsule around them, and the degree to which this is likely to contract is thought to be related to a number of factors including implant surface, placement, and implant contamination.
Lower rates of capsular contracture have previously been reported with implants put underneath the muscle, but this is partly due to the implants having more coverage and therefore when capsular contracture does occur it is less likely to be reported by the patient. Implant technologies have moved on significantly, and the risk of capsular contracture, even with a subglandular augmentation (in front of the muscle) is low. There are a number of advantages of subglandular placement that you may feel outweigh this risk.
In my practice, getting the implant placement right for the individual patient is important, and the risk of capsular contracture is one of a number of factors that will feed into this - the risk/benefit profile of each of the decisions that you make about your implants (surface / shape / dimensions / placement) should be discussed with your surgeon and individualised depending upon your priorities.

Capsular contracture can occur with implants placed both above and below the muscle, but below the muscle simply carries a slightly lower risk. If you want implants above the muscle and you are a good candidate then it's fine to proceed as planned. I've included a video on capsular contracture that I hope you find helpful.