African American woman concerned about post breast implants hardening and capsular contracture. What are your thoughts?

I am an African American 5'10, thin woman who want to get breast implants. Where would you recommend my incision be? I have heard capsular contracture is more common in African American women. I also, would like to know what time of implants I should get because I have heard as well that women of my ethnicity tend to have there breast get more firm and less natural after surgery. Thanks in advance!

Doctor Answers 4

Hardening of the Breasts and Black Women

I've had well over 20 years of experience in Plastic Surgery in a city with a large black population and have not seen a larger rate of capsular contracture/ hardening of the breasts among my black patients. Current thinking is that the hardening of the breasts is associated with seeding of the implants by bacteria either at the time of surgery or years later. Using meticulous surgical technique, washing the pockets with antibiotic solution, using a Keller funnel and promptly treating subsequent urinsry tract infections can prevent many subsequent contractures. 

Dr. Peter. A. Aldea
Memphis, TN

Memphis Plastic Surgeon
4.9 out of 5 stars 102 reviews

Capsular contracture is NOT more common in African Americans

Thank you for your question I have never found an association between ethnic background and capsular contracture, let alone African American. Basing your decisions on evidence-based research is highly important. There is no scientific evidence that being African American can increase your chances of capsular contracture or cause hardening of the implants. The literature review by Dr. Chong & Dr. Deva titled Understanding the Etiology and Prevention of Capsular Contracture, clearly outlines what can increase and decrease the chances of capsular contracture and all things are ultimately related to implant contamination. Initiators:
  • Bacterial Infection
  • Periareolar incision (natural bacteria of the breast can contaminate the implant during insertion)
  • Subglandular pocket (same reason as above)
  • Prolonged exposure of the implant to the surrounding surgical environment (lack of sterility in the surgical environment can cause contamination of the implant)
  • Hematoma (blood can increase inflammation and speed up fibrous capsule formation)
  • Use of drains (increase risk of infections by 5 folds, and thereby increase risk of CC)
  • Avoiding large implants (large implants can easily be contaminated)
  • Textured implants with submammary pocket (Textured implants may not help in the submuscular pocket)
  • Submuscular pocket (the implant is not exposed to breast’s natural bacterial flora)
  • IV antibiotics
  • Washing the implant pocket with antibacterial solution
  • Using insertion sleeves (i.e., Keller Funnel) for the implants (reduces contact with bacteria)
These are the only things research has shown to influence the risk of capsular contracture. The choice of incision and implant type/size all depends on your preferences, and your breast characteristics. Best incision would be Inframammary incision to minimize risks of all sorts of complications, let alone capsular contracture. However, these decisions cannot be made without an in-person exam and consultation. Please seek the advice of a board-certified plastic surgeon to undergo breast augmentation. Hope this helps.

Martin Jugenburg, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 415 reviews

Scarring & skin Type


There are reasons to believe that Capsular Contracture can be triggered by bacteria and bleeding inside the breast pocket, but not ethnicity. African and Asian skin types do present with higher rates of keloid/dark scarring however and I recommend that my patients treat their scars with Silicone sheeting for 4-6 months post op in order to reduce their prominence.

I recommend that you speak with your Plastic Surgeon about their methods for reducing the risk of capsular contracture and scar treatment post op.

All the best

Capsular contracture and incision

There are no studies that suggest you have any higher risk of capsular contracture than anyone else.   Capsular contracture is related to bacterial infection.  As such, your surgeon should take precautions which they can tell you about to reduce the chance of this.  I do this on everyone.  Incision wise, there are pros and cons to each incision.  Your surgeon can address this best face to face after examining you.  Surgeon preference is also an issue with incision location.  The infra-mammary incision for example has many pros and few cons in my experience.  I think you sound like an excellent candidate for an augmentation but do your homework and see one or more plastic surgeons to make sure all of your concerns are addressed. 

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.