Capsular Contracture Likelihood for Subglandular vs Submuscular?

Had surgery for cc of L breast (never went Bk to soft squishy state).now right cc.Chances of cc w/sub-glandular vs.sub-muscular? better to place both under muscle now?silicone implants frm06 periareiola incision.My weight fluctuates, when dwn see rippling which shouldn't see with silicone?Little ball like masses on outer edges of implants slightly smaller than marble dr says caused by cc?however its on bth breasts & according to him only my Rbreast has cc now? what are they?

Doctor Answers 6


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The capsular contracture and visible rippling is significantly less when the implants are in the submuscular space

New York Plastic Surgeon

Capsular contracture

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I prefer to place implants under the muscle for the two reasons you mentioned. It helps minimize rippling in the upper pole, and it is felt that capsular contracture rates are lower under the muscle.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Capsular contracture

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Hi Ladyluck,

     Capsular contracture and rippling are absolutely more common in front of the muscle.

Your best bet is to convert your implants to behind the muscle.  Since your incision is already around the areola, I would reused this approach and avoid a second incision..  In my experience there is no increased likelihood of capsular contracture through this  areola .approach.  With appropriate intra-operative antibiotics and and meticulous surgery, the capsular contracture rate in the submuscular position approaches one percent, perhaps even less, regardless of the incision.

Good luck,

Ary Krau MD FACS

Ary Krau, MD, FACS
Miami Plastic Surgeon
4.7 out of 5 stars 358 reviews

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Capsular Contracture Management

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    If you have subglandular implants and capsular contracture, you should replace the implants and transition to a submuscular plane.  Kenneth Hughes, MD Los Angeles, CA

Capsular Contracture Likelihood for Subglandular vs Submuscular

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Capsular contracture is less likely in submuscular implants. Given your issues with both CC and ripples, you would be best served by replacing your current implants with submuscular gel implants. your surgeon might want to consider and incision in the breast fold for this procedure. Without a photo or better still an exam, I am not certain as to what you are feeling around the implant edges, but I suspect they are ripples,  folds in the implant edges. 

All the best. 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon

Capsular contracture and implant placement

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CC is a complex problem and is the most common thing that destroys a nice breast augmentation.  Over the years there have been many attempts to determine whether implant placement and silicone vs saline made a difference.  In my opinion and experience, implants below the muscle are better and although I do 95% gels, I think the salines are a tiny bit less prone to CC.  Incision also matters and the areolar incision seems to have a higher risk than the crease.

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