Is it true that capsular contracture occurs in women with little breast tissue?

I'm getting a breast augmentation in 10 days and since it's so close I'm getting nervous especially since this is my first surgery. I don't remember where, but I read that capsular contracture occurs in women that don't have a lot of breast tissue. I just want to know if this is true. I have a lot of breast tissue because I'm around a C/D cup. I just don't want this to happen to me. Thank you!

Doctor Answers 8

10 days post op, some advices:

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Thanks for the question.

In my practice, after performing a BA I recommend to my patients to limit the movement of the arms for two weeks. After that, you can move your arms taking care and always with common sense. 
In this regard, it's not advisable to carry heavy weights to prevent the implant out of position, and allow the formation of the physiological capsule around the implant, also to avoid pain and breast swelling. 

Kind regards

Dominican Republic Plastic Surgeon
4.7 out of 5 stars 307 reviews

Is capsular contracture more common in women with little breast tissue?

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I am unaware of any proven association between the amount of breast tissue present and capsular contracture. However, there are several aspects of a breast augmentation procedure which can help minimize capsular contracture such as: placing the incisions along the lower breast fold, utilizing a submuscular pocket, placing tegaderm sheeting over the nipples after the surgical prep, placing the implants utilizing the "no touch" technique with the Keller funnel (to minimize the presence of bacteria or biofilm formation on the implant itself), irrigating the implant pockets with an appropriate antibiotic solution and in my opinion early post operative breast implant movement exercises. Best of luck!

Capsular contracture

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Thank you for your question! To my knowledge there is no association between amount of breast tissue and capsular contracture. No one really knows exactly why capsular contracture occurs but there are some theories. One of the most accepted theories has to do with possible bacteria that make their way into the breast implant pocket. There are many things that are done to decrease the bacterial count and the risk of contamination. Some of these things can include giving the patient antibiotics and washing the implant and the breast implant pocket with antibiotic wash. There are certain things that have been shown to decrease the risk of contracture including but not limited to placing the implants under the muscle, using textured implants, meticulous hemostasis and the washes I spoke of earlier. Each of these has their own pros and cons and would be best to discuss these with you plastic surgeon. Hopefully you are being treated by a board certified plastic surgeon! Good luck!

Ankur Mehta MD

Capsular Contracture

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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 associated with lack of breast tissue?

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I have been performing breast augmentation for 30 years.  There is no association with capsular contracture and small breast tissue that I know of or have experienced.  However because there is so little breast tissue covering the implant sometimes the breast may seem a little bit firmer because of the lack of breast tissue.  The main difference that I have seen with decreasing capsular contracture over the years has been the use of the Keller funnel and the so-called no touch technique.  This has decreased the amount of reoperation for contracture to about 1% in  our practice 

Andrew Kaczynski, MD (retired)
Sacramento Plastic Surgeon

Capsule Contracture Around Breast Implants: Causes and Prevention

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As long as breast implants have been used for breast enlargement, there has been the risk of the scar capsule that forms around an implant contracting or shrinking, which compresses the implant into a smaller space, thereby creating a firmer, more spherical breast.  It is important to realize a few things.  First, every time an implant or any other foreign body (such as an artificial joint or a heart pacemaker) is placed in the body, the body's wound healing will create a scar capsule surrounding the implant.  In some people that capsule will shrink or tighten up, and that is a capsule contracture.  Second, although we don't know for sure what causes this problem, the most common theory is that there may be stimulation or irritation of the scar capsule by bacteria in the area that live in breast glands.  Anyone who has breast implants can possibly develop capsule contracture.  The most common way to prevent this is by placing the implants behind the pectoral muscles, irrigating the implant pocket thoroughly with antibiotic solution, soaking the implants in antibiotic solution, and minimizing post operative bleeding.  Also, some research suggests that textured surface implants have a lower risk of capsule contracture than smooth surface implants.  I don't think that the breast size affects the likelihood of developing capsule contracture, but it does make sense that a very small breasted woman, whose skin is tight to start with, will be tighter with a larger implant than a woman whose breast skin is looser.

Capsular contracture associated with lack of breast tissue?

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Thank you for your question.

I have never found an association between amount of breast tissue and capsular contracture. Basing your decisions on evidence-based research is highly important. If I were you, I would ask your surgeon what he/she thinks about this finding of yours.

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


  • Bacterial Infection
  • Periareolar 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)


  • Avoiding large implants (large implants can easily be contaminated)
  • Textured implants with submammary pocket (Textured implants may not help in the submuscular pocket)
  • Submuscular pocket (the implant is not exposed to breast’s natural bacterial flora)
  • IV antibiotics
  • Washing the implant pocket with antibacterial solution
  • Using insertion sleeves (i.e., Keller Funnel) for the implants (reduces contact with bacteria)

These are the only things research has shown to influence the risk of capsular contracture.

Please consult with a board certified plastic surgeon and clearly communicate your goals, desires, fears, concerns about proceeding with a breast augmentation surgery.

Hope this helps.

Capsule contracture risk

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Thank you for your question.  I am not aware of relationship between breast volume and capsular contracture rates.  The underlying cause of capsule contracture is unclear, but a low grade bacterial infection is the most commonly cited reason.  Because of this, your surgeon will usually wash the implants and breast pocket with an antibiotic solution and prescribe antibiotics around the time of surgery.  We do know that placing the implants under the muscle will decrease contracture rate.  Also, avoiding a peri-areolar incision and use of textured implants tend to decrease the encapsulation rate.  Good luck.  

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.