The rate of capsular contracture has decreased significantly since the '80's and now is consistently less than 5%. Placing the implant behind the muscle, using an incision in the breast fold and using a no touch technique to place the implant in the pocket as well as soaking the implant in antibiotic solution have been shown to decrease the rate of capsular contracture. Discuss your concerns with an experienced, board certified plastic surgeon.
How common is capsular contracture? Is there any ways to prevent it?
Doctor Answers 8
Minimizing capsular contracture
Early on, capsular contracture can be reduced with sterile technique, antibiotics, and more modern implants. Unfortunately the studies that look at these techniques have an average follow up of 2 years, and rarely past 6 years. So while we can reduce earlier capsular contracture, the rates slowly climb to >10% at 10 years. In cosmetic surgery subglandular implants and revision surgery increase that risk over time, and the rates with reconstruction are higher particularly if there has been radiation. Good implants and modern techniques can reduce early contracture and delay it for years but does not eliminate capsular contracture entirely.
How common is capsular contracture?
Capsular contracture have been carefully studied, and though there are steps we take to reduce the risk we have not been able to prevent all. The reported rates are about 2% to perhaps 10% and vary by the technique and implants used.
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How common is capsular contracture? Is there any ways to prevent it?
Excellent question. The overall rate of capsular contracture including all surgeons is 9.5% whioch is a great improvement over the 30% rate in the 1980's with the old silicone implants.
However this rate can be reduced to 3.5% by using:
- The no touch technique
- Triple antibiotic irrigation
- Placing the implant underneath the chest muscle
- Using the incision under the breast
- Using the Keller funnel
- Meticulous careful surgical technique
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Hello and thank you for your quesiton. Capsular contracture is probably the most challenging problem we encounter with breast augmentation. The cause is secondary to thickening of the usual thin layer of scar tissue (capsule) that develops after the implant is placed. Although we are not sure what causes the thickening most of the time, we do know that blood that accumulates around the implant or a small amount of bacteria (biofilm) can definitely cause it. It is extremely critical that your surgeon and his operating room have a lot of experience in sterile technique and almost completely eliminate any blood loss. The usual amount of blood loss during a breast augmentation in our facility is basically zero. Per your question, the capsular contracture rate varies widely depending on which surgeon is performing the procedure and what type of implants and what kind of patients (cosmetic or breast reconstruction). Most studies for smooth silicone cosmetic implants demonstrate a capsular contracture rate about 5-8% with textured implant rate a little less. If capsular contracture does occur, several steps can help to resolve the issue. A lot of surgeons use a product like Accolate or Singular which impairs the inflammatory cascade that causes the thickening. I have had great success with this medicine. If the implants remain hard, then a capsular release or capsule removal has to be done with surgery. This always eliminates the problem but on rare occasion the same thickening can occur.
Capsular contracture (CC)
CC occurs 100% of the time with breast implants. It is the body's response to a foreign object being placed in the body. It is similar to a knee or hip replacement, pacemaker, even a splinter in the finger. Our body responds with an inflammatory reaction and try's to "wall off" this foreign invader!
With breast implants we want CC to be minimal and not effect the final result. There are 4 grades of CC, I, II, III, IV. I is the softest, II is slightly firm, III is firm and visually noticeable, IV is firm, hard, visually noticeable and painful. CC grade I and II can be managed with breast implant massage and oral medications. CC grade III and IV probably need surgical correction.
The cause of CC is unknown, the surgeon uses techniques during and after the procedure to minimize CC. The percentage of patients that develop grade III and IV CC is debatable and probably around 5-10%.
Always consult with a Board Certified Plastic Surgeon who specializes in breast enhancement procedures to assure the best possible result.
How Common is Capsular Contracture?
Thank you for your question, it's a very good one, and is still being hotly debated by the plastic surgery community.
Rates of capsular contracture vary widely in the literature. Because we don't know exactly what causes it, it's hard to know what steps are necessary to prevent it from happening (our best guess seems to be a chronic inflammatory process, likely most often from a low level of bacteria on the implant). It appears there are some things that can be done to decrease the risk, such as placement under the muscle, placing the incision under the breast (or possibly using a funnel), antibiotic irrigation, not having blood in the pocket, using the latest generation silicone implants, and texturing of the implant.
Again, all of these things aren't known for sure, and some plastic surgeons disagree with them. Over time, we will be able to find out more about the cause, and ways to prevent it even more.
The most important thing is to find a plastic surgeon whose results you like, and whom you trust to give you the outcome you desire.
Dr. Dan Krochmal
MAE Plastic Surgery
How common is capsular contracure after Breast Augmentation, and can anything be done to prevent it?
Thankfully the complication of capsular contracture after Breast Augmentation (a tight scar around the breast implant that can result in unusual breast firmness) is not common in most practices. While capsular contracture is the most common complication after Breast Augmentation the rate of occurrence is really quite low, considering the body's immune system response to any foreign object placed under the skin. The reaction of the body that results in a capsular contracture has been extensively studied. Changes in techniques and implants has led to a decrease in the rate of capsular contracture, but there is no getting around the fact that the body's immune system will always react to a foreign object under the skin as a potential danger, and create a wall of scar tissue around the implant to protect itself. If this scar is thick, then the result is a tightening of the scar around the implant and firmness of the breast. Attempts have been made to modify the immune system response, but this can lead to other issues including poor healing, infection, and other organ complications. A healthy lifestyle, careful surgeon, prevention of infection, submuscular implant position, and appropriate recovery schedule will all play a role in decreasing factors that could start an over-reaction by your immune system which could lead to capsular contracture.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.