How to reduce risk of capsular contracture before first breast augmentation?

Capsular contracture is a well known complication of breast augmentation surgery. While the cause of capsular contracture is not completely known, there are several things that can be done in an attempt to decrease the risk. Placement of the implant under the pectoralis muscle, meticulous surgical technique and the use of an implant funnel and the "no touch technique" are all believed to reduce the risk.

Hi, thank you for your question. If you have already received your implants, there is likely little that you can do now to prevent formation of a contracture. Follow the instructions set forth by your plastic surgeon. Proper surgical technique is the biggest factor in prevention as we currently understand it. Once a capsule forms, if it becomes symptomatic, surgery is likely the only best solution. I hope this helps. Best of luck! 

Hello Jubilant2138,


I appreciate your questions! Hardened breast implants (capsular contracture) are one of the more common problems with breast implants, with clinically significant rates reported at 15-45%. The earlier
you seek treatment for this issue, the better. Capsular contracture
is actually caused by the body reacting to foreign substance of the
implant. It forms scar tissue around the implant, squeezing it. Once
this occurs, the implant no longer has leeway to move
around naturally, and instead it is fixed into place by the scar
tissue. This is not only painful for the patient, but it also causes the
breasts to look very unnatural or disfigured. It should be noted that
saline implants have a lower rate of capsular contracture
than silicone gel-filled implants, and that the risk of capsular contracture
is significantly reduced with Dual-Plane breast augmentation and the
“No-touch-technique” implant placement. With subglandular (over the
muscle) implant placement there’s a higher
risk of capsular contracture (almost 1 in 4 women). Other factors that may increase the risk of developing capsular contracture
include: post-surgical complications like hematoma (broken blood
vessels under the skin), seroma (collection of fluid under the
skin) and bacterial infection. Hope this is helpful! Dr. De La Cruz.

Capsular contracture is an incompletely understood entity in which many theories have been postulated but none have been substantiated.  Capsular contracture is very difficult to evaluate without a physical exam.  If the breasts are soft and pliable, capsular contracture is not likely.  Capsular contracture can occur in even the most careful surgeon's practice, and we do not know everything that is responsible for the occurrence of capsular contracture. 
The most important thing in this consideration is to find a PS who does hundreds of breast augmentations and revisions who is very sophisticated in the approach to treating capsular contracture should it occur.  

Thank you for sharing your excellent question.  As you mentioned it is impossible to eliminate the possible risk of CC but your physician can do a number of maneuvers during surgery to minimize the possibility.  This can include everything from location of incisions, the sterilizing product for your skin and implant, no-touch implant technique, etc.  Because each surgeon has their own technique, best to address this directly during your consultation.  Best wishes. 

This is a great question and the best remedy for capsular contracture is to never have it in the first place.  Surgical technique is critical with a bloodless dissection.  Submuscular pocket placement has a lower incidence of capsular contracture.  Bacteria may also play a role.  Triple antibiotic irrigation with betadine is critical in preventing any bacterial contamination.  Finally, it may be helpful to take an antibiotic around the time of dental work to prevent bacteria from seeding the implant.

The only things that could be controlled are: to have the surgery when you have no infection going on (UTI, dental cavities, etc) and not taking blood thinners (aspirin, fish oil, etc) to minimize risk factors for capsular contracture. But despite, all it could happen. It's like asking how to reduce risk of scarring before an injury even happens. After the fact, there are ways to minimize the risk, some controlled by your board certified plastic surgeon, some by you. Best of luck and be safe!

Capsular contracture refers to scar tissue that forms around a breast
implant, causing the breast to harden. This may cause the breast to
look or feel different, and may result in some discomfort from the
tightening of the capsule, and it may case the implant to ride high on
the chest wall. 
The cause of capsular contracture is essentially
unknown, but there are external factors that can raise the risk of
occurrence; including patients who are smokers, patients who choose very
large implants over 500 cc, subglandular (above the muscle) placement,
and patients who have developed a hematoma post surgery.
There are
several steps that can be taken to reduce the risk of capsular
contracture. First, the majority of my breast implant procedures are
placed under the muscle (submuscular), which reduces the risk by
approximately 8- 12% over the patient’s lifetime. Over the muscle
(subglandular) has a 10-25% chance of capsular contracture. If the
implant is placed on top of the muscle, I recommend using a textured
implant to help deter capsular contracture formation. The rough surface
discourages a hard capsule of scar tissue from forming around the breast
implant.
Other methods I use include sharp dissection when creating the pocket
for the implant to reduce the amount of bleeding from the procedure.
Also irrigating implant pockets with a triple antibiotic solution may
help reduce the risk of infection. Additionally, the ‘no touch’
technique to place the implant using a ‘Keller Funnel’. These measures
help ensure that no foreign substance attach themselves to the implant,
which could inflame the surrounding tissue and cause complications such
as capsular contracture.
One month after surgery, I recommend my
patients massage their breasts to prevent scar tissue from forming
around the implant. Breast massage can help the breasts soften
post-operatively. I recommend continued daily massage, which can even be
done in the shower, by moving your breast implant around in the
surgical pocket and pushing it up and down, and side to side as far as
possible in the pocket. This will ensure they continue to move naturally
like your own breast tissues.
Hope this helps.Kamran Azad MD, Board Certified Plastic Surgeon

After all these years we still don’t truly know what causes capsular contracture. There are many theories. One thing is certain however.saline implants have a much lower incidence of capsular contracture than silicone gel. Why that is nobody is certain but using saline implants would be the one thing you could do that would reduce the risk of capsules substantially.  I often use saline implants and I cannot remember the last time I saw capsular contracture in them. Also have them  placed under the muscle.

We know that the risk of capsular contracture is higher in smokers, obese patients, patients who have had prior breast surgery or combination surgery (augmentation with a simultaneous breast lift), and patients who may have experienced trauma, which can result in internal bleeding, and therefore inflammation. There is anecdotal evidence that it is also higher in red heads. Other than these factors, enjoy your life and hope that you don't develop one. If you do, please return to your plastic surgeon, or seek out the opinion of an experienced board certified plastic surgeon. Best of luck to you.