Bigger silicone breast implants more prone to capsular contracture?

Question

Is it true that the bigger the Silicone breast implants are, the greater the chance for capsular contracture is?

Steven Teitelbaum, MD · Answer

The size of the implant does not influence the likelihood for contracture...UNLESS...you get an implant so large that the surgeon has to cram and force it into the space, thereby creating excessive trauma and bleeding, which do contribute to contracture.
 
But implant size does affect other things that can be even more problematic than contracture, such as malposition, tissue thinning, and skin stretch.  Those are reasons enough not to put in any larger of an implant than ideally fits within your tissue.  As much as women hate capsular contracture, it is not one tenth as disconcerting as having implant visibility and rippling, both of which occur more often as large implants create the tissue over them to thin with time.
 
So...implant size should not be subjective.  You should be measured and receive the implant that fits your tissues.  In all of surgery, there is no other prosthesis inserted into the human body in which the patient is allowed to dictate the size.  Choose the implant that fits, and you will have the best long term result.
 
S

Trevor M. Born, MD · Answer

Dear Sam 79
 
There is no definite findings in the literature of a greater incidence of capsular contracture of larger vs smaller silicone implants.
A recent study showed an incidence of 2 to 5 % capsular contracture in relation to silicone implants. There was a slight increase in rate with the Allergan implants but i would not say that this was significant.
Capsular contracture can occur any  time after surgery but is most common in the first 3 to 6 months after surgery.
 
With Warm Regards,
Trevor M Born MD

Christopher L. Hess, MD · Answer

The early days of breast implants was largely focused on silicone implants due to their more natural feel.  All implants were placed into the subglandular position.  Unfortunately, as the use of these implants progressed they were found to have a substantially greater risk of capsular contracture over saline implants.
Many different techniques were tried to prevent the capsular contracture including the use of saline implants.  Eventually it was determined that if the implant was placed in the submuscular position (being fully covered by muscle) then the capsular contracture rate not only decreased for silicone implants but it equaled saline implants which also decreased.
Further refinements in technique determined that if the implant was only covered by the pectoralis muscle (subpectoral) and therefore approximately 80% of the implant was covered they still maintained low capsular contracture rates.  Which is where we are today.
Size has nothing to do with the capsular contracture rate but does carry other issues such as thinning of the overlying breast tissue.  See the article below for a good history of implants.

Jeffrey Zwiren, MD · Answer

The size of the implant would have little to no affect on the development of a capsular contracture. However, time, weight and gravity are not on your side with a breast implant. The heavier the implant the more risk you have for implant malposition. This is a downward displacement of the implant. Typically if this occurs the implant will drift laterally especially when you lay down. To get the best result an experienced plastic surgeon will help you select an implant that is appropriate for your size, shape and tissue characteristics.

Michael C. Edwards, MD, FACS · Answer

Larger implants are not known to cause a higher incidence of capsular contracture. In fact, one could argue that the weight of a heavier implant may help keep the capsule stretched to some degree as long as it was placed using meticulous sterile technique without excessive bleeding around the implant.
 
Dr Edwards

Steven Wallach, MD · Answer

I do not think that size specifically has any association with the risk of forming a capsular contracture. No one really knows for sure. The most common theory is that there is a subclinical infection that causes the body to react this way.

Richard P. Rand, MD, FACS (retired) · Answer

There are elevated risks associated with larger implants such as numbness, but an increased risk of capsular contracture is not one of them to my knowledge.

Bigger silicone breast implants more prone to capsular contracture?

Answers (7)

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