How common is capsular contracture and is there anything I can do to help prevent it?

Doctor Answers 6

Breast implants capsule contracture

Dear pinkcotton,
    Capsule contracture is relatively low. The most common reasons for capsule contracture are infection, bleeding and natural contracture of the scar around the implants. When the contracted capsule is thin and at,  so called Baker contraction level 1 or 2 , all that is needed is implants displacement massage. When the capsule is thin but more intensely contracted, capsulotomy is required. When the capsule is thick   and the breasts are hard ( Baker 3 and 4 ) due to Biofilm ( bacteria on the implant and in the capsule ), capsulectomy with implant replacement is the only way to go. How do you reduce the occurance of capsule conracture ? Here are my recommendation as I do it in my practice : 1. Diet. Avoid blood thinners like aspirin, tomatoes, MSG etc or caffein that can raise blood pressure, 2 weeks before and after surgery. ( caffein only the night before and 2 weeks after ) 2. Antibiotics , starting the night before surgery and continueing for 5 days. 3. Avoid physical activity for 2 weeks after surgery followed by moderate activity for additional 2 weeks. 4. No bra during day time for 1 month, so the implants can weigh down on the submammary cease and prevent upward contraction. 5. Implants displacement massage for 1 year. 6. Contact the office immediatly with any sign of infection. Mainly redness around the incision. 7. 1 dose of antibiotics whenever having dental work or colonoscopy to avoid dissemination of bacteria. 8. Surgery in accredited facilility where sterility is maintained.
    I hope this helps,
                All the best,
                        Dr Widder


Capsular contracture after breast implants

  • Depending on the study, capsular contracture after breast implants ranges from 3% up to 15%.
  • Although there are a range of possible causes ranging from sleep position to a blood clot around the implant, research shows the most common cause is a single layer of bacteria that settles around the implant,
  • These bacteria cannot be reached by antibiotics and cause chronic inflammation,

  • Many things today are done to minimize the risk.
  • They include implants under the muscle, no touch techniques of implant placement, incisions under the breast (avoiding the bacteria in the nipple and under the arm), cohesive gel implants and textured implants.
  • Maximum precautions are - in my opinion - truly helpful because once a capsule forms, it can be expensive and difficult to correct. best wishes.

Risk of Capsular Contracture after Breast Augmentation

Capsular contracture rates vary dramatically depending on techniques and different surgeons. In the literature, papers vary widely in what capsular contracture rates are, depending on different studies. There are some things that I feel have been shown to reduce capsular contracture rates. One is the use of textured implants over smooth implants. Secondly, would be the use of an inframammary or under the breast incisions with nipple shields to minimize risk of contamination of the implants. Thirdly, would be placement of implants under the muscle as opposed to on top of the muscle. Lastly, would be the use of a funnel device such as a Keller funnel to place the implant with a minimal amount of skin contact. In conjunction with this, I always use a triple antibiotic solution and I wash the pocket out multiple times during surgery. I also place the patients on antibiotics prior to the initial incision, and I keep them on antibiotics for a few days after surgery. All these actions help to reduce the previously overall risk of capsular contracture and since I have made these changes in my own practice a number of years ago, my personal capsular contracture rate is down to 1%. Capsular contracture can be very difficult to deal with so I certainly would recommend doing anything possible to prevent this from occurring in the first place.

Robert Cohen, MD
Santa Monica Plastic Surgeon
5.0 out of 5 stars 39 reviews

Preventing capsular contractures... aka CapCon

Risks are real for developing one over the lifetime of your implants that can vary from 3-15%.  Most of prevention comes from what is done at your surgery, whether you have complications after (bleeding), and your implant type and position.  Some surgeons are not as meticulous as others and they will experience a higher capcon rate.  Just as some doctors have more bleeding or infections than others.  Off label use of some asthmatic medications are used in dire situations where you have nothing to lose by taking it.  So in the end, there is very little you can do yourself but choosing a good surgeon is imperative.

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 32 reviews

Capsular Contracture


Unfortunately,  capsular contracture is second only to rippling as the most common complication after breast augmentation. Data reported to the FDA from the implant manufacturers regarding capsular contracture, as well as other previously published independent data is around 15% in the first three years.  This is unnecessarily high, as many surgeons are now reporting capsular contracture rates as low as 2% to 3%.

Capsular contracture is a reaction to bacterial contamination of the implant shell and the subsequent formation of a 'biofilm' which stimulates inflammation and abnormal collagen deposition in the scar capsule.  This bacterial exposure usually occurs at the time of surgery, but can also happen later due to blood born bacteria after 'dirty' procedures like teeth cleaning.

Anything that can decrease the risk of either implant exposure to bacteria or biofilm formation is likely to reduce the risk of capsular contracture. A list of factors that have consistently been shown to reduce capsular contracture includes:
1. Dimensional planning of the implant size.
2. Avoiding the periareolar (nipple) incision.
3. Subpectoral placement of the implant.
4. Meticulous, electrocautery dissection of the pocket.
5. Irrigation with triple antibiotic saline and betadine prior to implant placement.

Additionally, there are other things that probably have a beneficial effect on the prevention of capsular contracture but have not been scientifically proven as significant yet:

1. The use of an implant delivery funnel, also known as the 'no touch technique'.
2. Avoiding surgery with an active bacterial infection like a urinary tract infection or a tooth root infection.
3. Anytime in the future after the surgery, the use of prophylactic antibiotics prior to teeth cleaning or procedures involving   instrumentation of the urogenital or anal regions like pap smears, colonoscopies, etc.

Implant massage after breast augmentation has not been shown to either prevent or treat capsular contracture. Implants with textured shells have had conflicting reports of either no benefit or small benefit when placed in the subpectoral position.

Finding an experienced surgeon that has an excellent reputation for cosmetic breast surgery is likely going to result in a low risk breast augmentation with a high probability for success.

Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 78 reviews

Prevention of capsular contracture

Currently with the new cohesive gel breast implants capsular contraction rate has been reduced to 4.5-6.9%

Meticulous "no touch" surgical technique is recommended in an attempt to help reduce bleeding and trauma during surgery and hopefully decrease capsular contraction.  The technique of your surgeon cannot be overemphasize in importance for avoiding capsular contraction.

The placement of your breast implants beneath the chest muscle called sub-muscular breast augmentation also reduces the chance of capsular contraction and provides better coverage for the implant.

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.