What is Capsular Contracture?

What does capsular contracture mean? I just want to make sure what it because I may have it. Thanks

Doctor Answers 7

What is Capsular Contracture?

You may have heard of someone's breast implants 'turning hard'. It is not the implants themselves that turn hard, of course; what has really happened is that the fibrous capsule around the implants has tightened and thickened, making the implants less mobile and causing them to feel firm (and eventually, in some cases, even 'hard'). The medical term for this phenomenon is 'capsular contracture'. It is a problem that is best managed by avoiding it altogether, and fortunately there are a number of things that can be done on the day of surgery to guard against it.

Any time a foreign object is implanted in the body, whether it is a pacemaker or a breast implant or an orthopedic device or anything else, the body responds by forming a thin, wispy, fibrous membrane around it. In most cases this membrane or 'capsule' stays thin and wispy, but in some cases over time the capsule may tighten around the implant and thicken, making the implant feel firm or even hard. In advanced stages the contracted capsule can even distort the shape and position of a breast implant. Capsular contracture can be treated, but it is a surgical treatment, so avoiding capsular contracture is all about avoiding another trip to the operating room.

Capsular contracture can occur on one or both sides, and while it can develop early (weeks) or late (years) after a breast augmentation surgery, in the vast majority of cases it is evident fairly early following the procedure. So the good news is that once you are six to 12 months out from your surgery, if your augmented breasts are soft and supple then they are likely to stay that way for the long term.

It is believed that capsular contracture is primarily a response to the presence of low-virulence or non-virulent bacteria (i.e. not the kind that generally produce an actual infection, with redness/tenderness/fever etc) that adhere to the implant surface on the day of surgery, and which over weeks and months following surgery stimulate the cells that make collagen (called fibroblasts) to make more collagen - thickening the capsule and stimulating it to contract and tighten around the implant. It is not an actual infection; there are no symptoms that this is going on, and taking antibiotics will not prevent the process or reverse it. The source of these non-virulent bacteria is thought to be the patient's skin, or the ductal systems of the breast that lead to the nipple, as both are normally colonized with bacteria.

Because plastic surgeons now have an understanding of some of the reasons why capsular contracture occurs, there are a number of measures that can be taken to significantly reduce the likelihood that it will happen following breast augmentation surgery

Because of a number of techniques I use during breast augmentation surgery that are outlined below, I see very few capsular contractures in my breast augmentation patients. However, the reality is that if you are a breast augmentation patient with a capsular contracture, the incidence - at least to you - feels like 100%. A well-established capsular contracture can be corrected, but doing so involves a return to the operating room, removing and discarding the implant, removing or excluding the contracted capsule, creating a completely new implant space, and putting in a new breast implant (that statement may be somewhat controversial, but I believe the procedure just described is what is what provides a patient with the lowest risk of recurrent contracture). So I think that surgeons should feel obliged to do everything possible to limit the likelihood that a patient develops this frustrating postoperative problem.

Studies have shown that a bacterium called Staph epidermidis can be cultured from as many as 70% of capsule specimens obtained during surgical procedures for capsular contracture. So I employ a number of measure that address the possibility that skin bacteria or nipple duct bacteria may adhere to the implant surface during the augmentation procedure. We prep the skin using potent antiseptic solutions prior to draping the surgical site with sterile drapes, however the microscopic surface of the skin is full of peaks and valleys, and `nooks and crannies' - like sweat glands, hair follicles and sebaceous glands - that may harbor bacteria despite thorough application of an antiseptic prep solutions.

After prepping, we apply a new skin sealant product called InteguSeal to the skin surface where the incision is to be made. This effectively seals off all of the `nooks and crannies' that may harbor bacteria, and the sealant lasts for several days postop. We also apply it over the nipple and areola to seal off the nipple ducts which may also harbor bacteria.

Over the course of the surgery, we irrigate the implant space several times with a large volume of a saline solution containing three antibiotics (which can be modified in patients with an allergy to any of the antibiotics in the solution). Prior to implant placement, we irrigate the implant space with full-strength Betadine, a potent topical antiseptic that has been shown in clinical studies to reduce the incidence of capsular contracture.

I think one of the greatest advances in reducing the possibility of implant contamination by skin bacteria during breast augmentation surgery is the development of a soft, sterile, paper funnel for insertion of silicone gel implants into the implant pocket. This simple yet clever device actually looks much like a pastry chef's bag. It allows me to introduce the implant into the subpectoral pocket without ever touching it with my gloves, and without the implant ever contacting the patient's skin surface. The implant package is opened, the implant is irrigated with antibiotic solution then `poured' into the funnel, the small end of the funnel is inserted in to the skin excision which is held open with retractors, and I gently `squirt' the implant into the pocket. Before this was available, there was a great deal of implant contact with the patient's skin, under great pressure, as a pre-filled gel implant is forced into the pocket through a relatively small incision. The implant insertion funnel completely eliminates what I think has been the most concerning aspect of breast augmentation surgery in regards to the potential contamination of the implant with bacteria during the procedure.

There is no breast augmentation practice with a capsular contracture rate of zero. Yet there are obviously a number of measures that can be taken to make the rate of contracture as low as possible. I think it is important for patients to have confidence that their surgeon is focused not only on providing a breast enhancement that is beautiful and natural-appearing, but also on maximizing the likelihood that their aesthetically pleasing result will remain beautiful and natural-appearing over the long term.

Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 118 reviews

Breast Hardness

When an implant is places into the body, whether it's a breast implant or a cardiac defibrillator, the body tries to wall it off from everything else by putting a capsule around it. It's a foreign body that doesn't belong.

Capsular contracture occurs when this capsule becomes hard and essentially the implant won't move. It has several grades from palpable only to significant gross deformity of the breast.

We don't know why this occurs but we do know what can reduce its incidence: placing the implant under the pectoralis muscle, not putting betadine or antibiotics into the pocket using textured implants and others.

Capsular contracture typically occurs years after augmentation. So have your breasts evaluated by your plastic surgeon.

Christopher L. Hess, MD
Fairfax Plastic Surgeon
4.4 out of 5 stars 33 reviews

Capsular contracture causes breast implants to feel hard.

Hi! Every one forms an internal lining around the breast implants, and this lining is called the capsule. This is normal. It is how the body isolates the implant.

In some women, and for reasons that are only partially understood, this internal lining or capsule begins to tighten or shrink or contract. When the capsule contracts, it squezzes the implant and makes it feel firmer or even hard. This process is called capsular contracture, and it can be very mild (slightly firm implant) or severe (hard implant). The severe form is very rare in our experience.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon
4.8 out of 5 stars 9 reviews

Capsular contracture

Capsular contracture refers to the process of the body forming a tight wall around a breast implant. No one knows why this happens. One theory is that it is due to infection.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

It is an abnormally firm scar around the implant

The human body recognizes all foreign objects inserted into it and walls them off by building a scar around them. This is called a "capsule" and is a normal reaction. All breast implant patients have "capsules." The abnormal form of this is an exaggerated version called "capsular contracture." It presents usually within the first 2 years after augmentation as a frim, harder scar that can distort or move the implant and can cause pain.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
4.8 out of 5 stars 67 reviews

Breast implant capsular contracture

Any implant, breast implants included, stimulates the body to form a capsule around it that is comprised of collagen fibers and some cells. It is thought that some cells, called myofibroblasts, act like muscle cells and can contract or shorten. When this happens, the capsule surround the implant shrinks. If carried to its extreme, it would shrink to a point (i.e. collapse). As it shrinks around the implant, the contents of the capsule increases in pressure just as if you were to squeeze your hands around a balloon. The more you squeeze, the higher the pressure. If the capsule is the same size or larger than the implant, then the pressure is the intrinsic pressure of whatever is in the capsule. A saline implants has higher pressure when filled to maximum than the silicone gel so the silicone gel impants is softer. Surgeons become conceerned with capsular contracture of grade 3 or 4. Grade 3 is when the implant feels firm and distorts the shape of the breast and grade 4 is when it is firm and causes pain. Grade 1 is when the implant is soft and the shape is normal and grade 2 is when you can feel the implant but it doesn't distort the breast.

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 11 reviews

A capsule is a scar that forms around the implant

When ever an implant is placed in the body (breast implant, pacemaker, hip joint, etc.) the bodies natural response is to wall it off with a scar referred to as a capsule. Capsules unfortunately have the ability to contract or get tighter but rarely stretch or expand. It should not be considered as a complication of surgery but a normal response. We, as plastic surgeons do everything we can to to minimize the impact of this capsule by having your massage with smooth implants, placing the implant partially under the muscle, using proper irrigation and antibiotics, etc. If you feel as though you have a capsular contracture because of breast firmness, go in to see your plastic surgeon for an evaluation. Best of luck

Dr Edwards

Michael C. Edwards, MD, FACS
Las Vegas Plastic Surgeon
5.0 out of 5 stars 35 reviews

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.