What is the rate of capsular contractures?

Thank you for your important question!

Capsular contracture refers to tightening of the scar tissue
that normally forms around the implants resulting in hardened, painful, and
abnormal looking breasts with varying degrees of severity. The capsule is
fibrous tissue that NATURALLY forms when anything foreign is placed in our body
– this happens with heart devices as well. However, when there is too much
inflammation, fluid collection, or bacterial contamination, the fibrous capsule
can start to scar down further and contract.

In general, capsular contracture (CC) can occur at any time,
but most cases are documented in under 12 months (i.e., anywhere from 3 months
to 12 months post operation). This is because it takes time for the fibrous
tissue capsule to form around the implant, and then it will have to scar down
(contract).

Nevertheless, CC can start early when there is significant
bleeding or infection or another co-existing problem.

There are 4 grades/levels of capsular contracture:

Grade I — the breast is normally soft and appears natural in
size and shape

Grade II — the breast is a little firm, but appears normal.

Grade III — the breast is firm and appears abnormal.

Grade IV — the breast is hard, painful to the touch, and
appears abnormal.

Often studies will only consider Grade 3-4 as capsular
contracture as they actually require surgery (i.e., tearing of the capsule, or
complete removal of the capsule and the implant). However, some will include 2
as well causing the rate of capsular contracture to be higher. So let’s first
understand that this is one reason for the variability in the rates. The risk
of capsular contracture can depend on many things like incision site, pocket
location, implant and surgical skills. From anecdotal evidence of many
surgeons, the rate of occurrence can range from 1-2%.

Older studies (i.e.,
before year 2000) report capsular contracture to occur in up to 59% of patients, and its recurrence after correction
surgery can be from 18.1-39.7%. More recent studies hint that capsular
contracture rates range from 1-2% for breast augmentations through the
inframammary incision and the transaxillary incision, although it could be higher (up to
9%) for surgeries through the periareolar incision.

Nevertheless, I don’t think you should be concerned over the rates
of capsular contracture from studies, because it clearly varies depending on
the surgeon performing the procedure as you noted. So it would be better to ask your surgeon
about the incidence of capsular contracture when they perform breast
augmentations. 

That being said, a
literature review by Dr. Chong & Dr. Deva titled Understanding the Etiology and Prevention of Capsular Contracture (CC),
clearly outlines what can increase and decrease the chances of capsular
contracture and all things are ultimately related to implant contamination.

 Initiators:

Bacterial InfectionPeriareolar incision (natural bacteria of the breast can contaminate the
implant during insertion)Subglandular pocket (same reason as above)Prolonged exposure of the implant to the surrounding surgical environment
(lack of sterility in the surgical environment can cause contamination of the
implant)Hematoma (blood can increase inflammation and speed up fibrous capsule
formation)Use of drains (increase risk of infections by 5 folds, and thereby
increase risk of CC)

Suppressors:Avoiding large implants (large implants can easily be contaminated)Avoiding use of drainsAvoiding manipulation of the implant and excessive exposure to open airTextured implants with subglandular pocket (Textured implants may not
help in the submuscular pocket)Submuscular pocket (the implant is not exposed to breast’s natural
bacterial flora)IV and oral antibiotic prophylaxis during and after surgeryWashing the implant pocket and the implant with antibacterial solutionUsing insertion sleeves (i.e., Keller Funnel) for the implants (reduces
contact with bacteria)Using nipple shields to prevent implant contamination from nipple
dischargeAchieving blood-less dissection using electrocautery

If these risk factors are considered and incorporated into
the surgical planning by your surgeon, the risk of capsular contracture
dramatically drops.

I hope this helps.

Thanks for your inquiry.  The numbers here will depend on the study
that you look at and the types of implants you use, but I would say the
national average is around 10-15%.  I hope
this helps. 

Hello,Thank you for your question. Since breast augmentation surgery techniques have evolved to reduce implant contact/contamination, infection, bleeding/hematoma,  and drains, the overall rate of capsular contracture has decreased. All of the surgeons in my practice perform these advanced techniques.  We have been able to reduce the rate of capsular contracture, one of the most problematic risks of breast augmentation, to just 1% compared to many studies in literature where the rate is 10%, or even a whopping 25% as recorded by a Health Canada study. A scar capsule naturally forms around the implant and should remain thin and pliable but can, because of various physiological triggers, thicken and cause deformation and discomfort. There are degrees of severity, the most severe which would require surgery to correct. I recommend that you talk with your chosen Plastic Surgeon about their plan to reduce the risk of capsular contracture. All the best

20bella:  You pose a very interesting question.  There is no one simple answer as it depends on many factors including implant manufacturer, type of implant, incision, location of implant as well as variances between surgeons regarding what each grade of CC "is".   But the shortest and probably best answer I can give you is below the muscle averages 5% while on top of the muscle is closer to 20%.  Hope this helps.Best of luck to you!G. Robert Meger MD

20Bella,
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, MD, MHA, MSCertified, American Board of Plastic Surgery Member, Am. Society of Plastic Surgery

There's no simple answer as was already stated elegantly by the two previous answers. In the community I'm practicing, the contracture rate is 1 to 5%. I see lower CC rates now as doctors perform surgery via the fold and use antibiotic solutions.Good luck, Dr. Aldo

Most plastic surgeons agree that implants below the muscle have a lower capsular contracture rate than those placed above. I tell my patients that in general the 10 year risk of capsular contracture is about 10-20%. All three major implant manufacturers do have a warranty on silicone implants if you were to develop a Grade 3 contracture. Certain intraoperative techniques such as nipple shields, changing of gloves prior to implant handling, minimal blood loss during surgery and precise pocket creation without the use of blunt dissection all have been shown to minimize capsular contracture. Use of triple antibiotic irrigation and the Keller funnel to place the implants into the pocket without touching the skin has also been shown to decrease capsular contracture.Best wishes,Dr. Ravi Somayazula

     Unfortunately, there is no simple answer to this question. 

      Because of the multiple factors involved in breast augmentation, such as type of implant, position of the implant (sub-glandular vs. sub-muscular), solution used to irrigate the pocket, incisional approach to place the implant (infra-mammary fold vs. peri-areolar, vs. armpit vs. other), smooth or textured implant, and experience of the surgeon regarding the dissection of the pocket and the handling of the implant, there is no exact rate. The time in years after the implants were placed also affects the capsular contracture rates, with lower rates quoted in studies that that were short term versus long term studies. 



    However, in an experienced plastic surgeon's hands who frequently performs breast augmentation, I would expect the capsular contracture rate to be < 10%

The published capsular contracture rates are below 10% and in most local practices below 5 but unfortunately statistics do not apply to individualsDr Corbin

Across the country, contractures are in the 20% range.   In better practices, they hover between 1-2%.   By contracture, we generally refer to an unnatural firmness of the breast after surgery.   What makes the breast feel natural after surgery is the ability for the implant to move when the breast is squeezed.   If the space, the pocket, is larger than the implant, the implant will move if the breast is squeezed and feel soft.    The the pocket is the same size as the implant, the implant will not move when the breast is squeezed and feel firm, rock hard in the worst cases.    The chance of this happening increases with the use of excessively large implants.