Who Can Develop a Capsular Contracture?

I'm considering breast implants and breast lift. Who can develop this problem after breast augmentation procedure?

I had my rhinoplasty done 4 months ago. The tip is refines and shortened. The tip is still swollen and hard because of scar tissue--really stiff. My plastic surgeon said that it will take a year for tip swelling to go down and show results.

I'm wondering if I'll devolp the same hard scar tissue after breast augmentation too that might cause rupture of breast or requring another surgery to remove the hardened tissue? Your help is appreciated in advance.


Doctor Answers 14

Capsular contracture after breast augmentation

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Thanks for the question.

The short answer is the scar tissue from your rhinoplasty is unlikely to be related to your risk for capsular contracture and anyone can get capsular contracture after breast augmentation.

It is not completely clear what causes capsular contracture.

Capsular contracture can occur as soon as 4 weeks after breast augmentation surgery. A capsule forms around any foreign body placed within the human body - this is a normal occurence and all breast implants have capsules around them shortly after surgery. The capsule is made of the following:

  • Blood vessels
  • Collagen
  • Myofibroblast

The capsular contractures can be identified as to a scaling from mild to very severe. The classis scale used by Board Certified Plastic Surgeons is the Baker classification.

* Baker I capsule is a soft breast without significant scar tissue.
* Baker II capsular contracture is a palpable scar tissue around the implant; however, not visible.
* Baker III capsular contracture is associated with visible and palpable hardening, leading to a deformed shape to the breast.
* Baker IV capsular contracture, most severe, is associated with hardening, palpable, visible and often a cold, hard breast that is very painful to even mild palpation.

Usually people with Grade I or II implants don't even notice the capsule.

Most surgeons agree there are things that predispose people to severe capsular contracture. These include:

  1. infection or contamination of the implants
  2. bleeding around the implant
  3. previous capsular contracture problems
  4. rupture of silicone implants (typically the older styles)

In our San Francisco area practice we use techniques to significantly reduce the chance of our patients having these problems.

We have also utilized techniques (like the placement of acellular dermal matrixes) to help patients who have had significant capsular contracture and have been referred for treatment by their original surgeon.

I hope this helps.

Breast implants can cause capsular contracture in anyone

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The simple answer is anyone can develop capsular contracture. But it is a statistical question of the percentages who do in all augmentations. Studies have shown the capsular contracture rates are very low -- in the single digits.

If it happens to you, then it is 100% for you, and you would be very unhappy. We as plastic surgeons can not predict who is going to have a capsular contracture. Please go see 3 boarded plastic surgeons in your area to discuss in greater detail, or until you fully understand the causes and treatments.

Regards from Miami

Breast Augmentation Complications

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Complications do not happen often but are related to the quality of the surgeon. So make sure you see a board certified plastic surgeon who has nice before and after results.

Capsular contacture is unpredictable and happens in about 7% of the patients who undergo breast augmentation. Some surgeons have higher percentage some lower. That is just a national average. There are things that I do in the operating room and outside after your surgery to help reduce the capsular contracture rate.

Hope that helps.

Anyone with breast implants can develop capsular contracture

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Anyone with implants can develop capsular contracture, and seemingly at any point postop. We really don't know what causes it so giving advice on how to avoid it is difficult. The only thing I know for sure will cause a capsule is a post op hematoma. For this reason, I try to keep meticulous hemostasis in surgery and to see all my breast augmentation patients within a day or two of surgery. Anyone with a possible hematoma is reexplored immediately. They are rare but, certainly will cause capsules down the road.

Capsular contracture of breast implants

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Anyone can develop capsular contractures. It is not known exactly why this occurs but certain situations increase the risk: infection, bleed, flu-like syndrome, hormonal changes. I doubt if there will be any correlation between the healing of your rhinoplasty and the healing of your breast augmentation.

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon

Capsular Contracture

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Everyone forms a capsule around a breast implant, artificial joint, etc. The rate of capsular contracture (when this capsule contracts making the implant feeling abnormally high and making the breast too round) was quite high 20-25 years ago. In my experience this occurs rarely now if certain conditions are met (for example, using proper sized implant). I know of no cases in which a capsular contracture led to an implant rupture.

John Whitt, MD (retired)
Louisville Plastic Surgeon

Hardness of the breast after breast augmentation is infrequent

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While hardness of the breast (capsular contraction) can develop after a breast augmentation in anyone, it is relatively infrequent. In the past with the old implants and the methods that they were inserted, the frequency was quite high. Now with the new cohesive gel implants and the new saline implants the incidence has markedly declined. There are a number of maneuvers that your surgeon can preform that will also markedly reduce the changes of hardness of the breast. The use of systemic antibiotics, the coating the implants and implant pocket with a combination of antibiotics, changing gloves and using a no touch technique as possible all have a major affect on lowering the frequency of hardening of the breast. If by chance you do get hard there are some drugs that can be used in an off label manor which frequently can reverse the hardness.

Risk factors for capsular contracture

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Scarring on the nose after rhinoplasty is not related to the type of scarring that occurs with capsular contracture. Most cases of contracture occur only on one side, so it is not simply the body's reaction to the implants either. It does seem to be slightly more common with silicone implants, and implants above the muscle. However, using good techniques it is not common, and the published statistics of more than 10% are far greater than what most of us see in practice.

Capsular contracture

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It is difficult to predict who will develop a capsular contracture. The cause is believed to be multifactorial in nature.

Does scar tissue formation after rhinoplasty predict capsular contracture with breast implants?

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Hi there-

There are two questions here...

First of all, there is no reason to believe that scar tissue formed after your nose surgery means anything at all if you were to have surgery on your breasts (or anywhere else on your body, for that matter).

Secondly, with regard to capsular contracture, here's what you need to know...

First the facts:

ANYONE can develop capsular contracture after breast augmentation, and in fact, given enough time after surgery, almost everyone will. In other words, it is best to understand that if you have your implants long enough, they will become tightly encapsulated- the key is to keep this from happening for many years, which we are successful at accomplishing in the vast majority of patients.

Because no one really knows for sure what causes capsular contracture, it is not possible to completely prevent it- it is (for now) going to be a risk of this type of surgery for every woman who has breast augmentation.

Nonetheless, breast augmentation remains one of the most commonly performed aesthetic procedures with the highest rate of patient satisfaction in the world because these problems are fairly rare.

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.