What can cause capsular contracture years after surgery?

Question

During my first breast augmentation consultation, I asked this question to the doctor. She said that any bacteria in my bloodstream could possibly be why some people get capsular contracture years after a BA surgery. If I have unhealthy gums and have Dental work done, was an example she gave. Is that true?

Donovan Rosas, MD · Answer

The etiology of capsular contracture is not fully understood. We do know that certain factors will predispose an individual to the development of a contracture including prior contracture, infection/biofilm, hematoma or other source of inflammation. It is also known that certain factors lower the risk including submuscular implant placement and the use of textured devices.With regards to your specific question, I would recommend antibiotic prophylaxis for any dental procedure (as transient bacteremia is a risk factor for implant contamination).As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Gerald Minniti, MD, FACS · Answer

Hello,Late term capsular contracture frequently occurs because of bacteremia from either infections elsewhere, like a tooth abscess, or more commonly from a non-sterile procedure, like dental work and Pap smears. Although it doesn't happen to everyone, it doesn't make it any less real. Best of luck!

Austin Hayes, MD · Answer

Thank you for your question. Capsular contracture can result from bacteria, blood, and possibly foreign material, such as the fibers from sponges, causing persistent inflammation around the implant. It's best to avoid a contracture in the first place, and in my office this starts with meticulous operative technique and use of the Keller funnel.

Benjamin Mandel, MD · Answer

Thanks for you question. Capsular contracture is still poorly understood. Everyone who has breast implants placed develops a capsule around their implants. Generally this tissue is soft, thin and supple. Some people, however, develop thickened, firm, and calcified capsules. If this occurs, the tissue can squeeze the implant, move its position (generally up) and at times cause pain: capsular contracture. Studies suggest that bacterial contamination may be one cause. Antibiotic irrigation at the time of implant placement can lower the rate of contracture. This, however, is only one piece of the puzzle. Other factors, such as placement in a sub-muscular pocket, can also help reduce this risk. There are still many unknowns regarding capsular contracture and there is much work to be done to understand what causes, how to prevent, and how to treat this disorder.

Daniel Barrett, MD · Answer

Dear devcm,capsular contracture happens. In fact, every implant has a capsule form around it, its just a certain percentage develop thick capsules. There is a lot we don't know about it actually. Some think that bacteria that gets on the implant during insertion can increase the risk. Thats why we use a Keller Funnel in our practice to reduce that possibility. Our capsular contracture rate is less than 2% because we use a keller funnel as well as meticulous operating room techniques.
  Daniel Barrett, MD, MHA, MS 
Certified, American Board of Plastic Surgery  
Member, Am. Society of Plastic Surgery

William Andrade, MD · Answer

Hello, capsular contracture is not completely understood.  Potential causes could be bacterial contamination around the implant, tissue buildup after postoperative bleeding, other sources of contamination like the microscopic fibers that come off surgical sponges or gloves, etc.

Ravi Somayazula, DO · Answer

Capsular contracture is mulifactorial. The literature demonstrates that bacteria can produce biofilm which can lead to capsular contracture. This bacterial contamination can occur at the time of implantation, which is why specific measures should be taken by your plastic surgeon  during surgery to lessen this risk including, covering the nipples, using the breast crease approach, triple antibiotic irrigation and changing of surgical gloves prior to handling the implant as well as delivering the implant into the pocket using a Keller Funnel. Also meticulous pocket dissection minimizing blood loss is paramount in mitigating the risk. Capsular contracture although possible anytime as long as implants are in place most likely occurs within the first 3-5 years. Theoretically, any hematogenous or bloodborne transmission of bacteria as may occur during dental work etc can potentially cause capsular contracture as well.Best wishes,Dr. Ravi SomayazulaBoard Certified Plastic Surgeon

Nicholas A. Flugstad, MD · Answer

Capsular contracture has a number of causes. It is one of the most common long term issues with breast implants, meaning there is risk of developing capsular contracture early or late in the life of the implant. Capsular contracture is decreased with inframammary incison placement, placement of implants under the muscle, use of antibiotic solution, use of the Keller Funnel, and possibly use of textured implants. Bacterial seeding from dental work may or may not be a factor. Hardening of implants can also be a sign of rupture, so make sure you get it checked out soon. See and American Board of Plastic Surgery certified surgeon.

Connie Hiers, MD, FACS · Answer

Yes, a capsular contracture may happen at any time after a breast augmentation with an infection or dental work that seeds the blood stream with bacteria. I instruct all my ladies to take preventive antibiotics before dental work, and not to ignore any infection.

Brooke R. Seckel, MD, FACS (retired) · Answer

Capsular contracture can occur years after surgery.  No one is absolutely certain what causes the late development of capsular contracture.  However the most common explanation is that some event has resulted in the seating of bacteria into the bloodstream which then attaches to the implants and causes the capsule.  Invasive dental work is one very common theoretical cause for late occurrence of capsular contracture.

What can cause capsular contracture years after surgery?

Answers (12)

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