If Encapsulation is Caused by Bacteria And/or Body Rejection, Why is It Only on my Dominant Side?

My theory is that I did too much too soon after augmentation surgery - excercise & just daily activities of a busy mom - using, of course, my dominant right arm. How long should post-op healing take? What do ya'll think?

Doctor Answers 9

Capsule after breast enlargement

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Your breasts should be soft and natural by 6 weeks after surgery for gel implants under the breast; up to 6 months for saline implants under the muscle. It takes longer for implants under the muscle on the dominant side to settle in position.

Capsules can occur early. There are 3 current research-based explanations - rejection is not one of them. The 3 possibilities are: 

  1. Biofilms (a layer of irritating bacteria over the implant.)
  2. Hugging one breast tightly with your arm while sleeping.
  3. Tissue irritation by leaking gel

Consider putting a pillow between your arm and your right side when you sleep. And discuss your result with your surgeon. Best of luck!


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There are and have been a number of theories as to why capsular contracture occurs.  The current prevailing theory is a bacterial cause which is a low level situation that does not produce the typical signs of infection. It is quite common for it to occur on one side and not the other or for it to be more pronounced one one side than the other. I do not know of any scientific evidence for the dominate side being more or less prone to capsular contracture. I do not think activity levels are a cause unless by doing too much you caused some bleeding around the implant , which has been shown to increase the risk of encapsulation.

Thank you for your question.

Ralph R. Garramone, MD
Fort Myers Plastic Surgeon
4.8 out of 5 stars 69 reviews

Why capsular contracture on only one side?

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There are many theories (and probable causes) regarding capsular contracture.  ONE theory involves "biofilms", a sub-clinical bacterial infection.  This problem (if it is the cause in your case) can happen on either or both sides.  I feel it is just coincidence that it occurred on your dominant side.  In fact, as stated by a previous Plastic Surgeon, one would expect the risk of capsular contracture to be slightly lower on the dominant side in a submuscular augmentation because of the increased "massaging" activity by the pectoralis major muscle on that side.

If Encapsulation is Caused by Bacteria And/or Body Rejection, Why is It Only on my Dominant Side?

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We really don't know what causes capsular contracture for sure and we don't think at this point that it is related to hand dominance. There is the theory however, that patients may be able to massage better with their dominant hand but on the opposite breast, so it stays a bit softer. Kind of like why right handed women breast feed more on the left!

John J. Corey, MD
Phoenix Plastic Surgeon
4.7 out of 5 stars 48 reviews

Capsular contracture often on only one side

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Capsular contracture is poorly understood, though it is not believed to be caused by any form of rejection of the breast implant. It does not have anything to do with a dominent side either, though it is very often a one sided event. Best of luck

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

Capsular Contracture Not Related To Dominant Hand

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It is extremely unlikely that your unilateral capsular contracture is related to your dominant side except by happenstance.  In fact the use of that side might well decrease the probability of contracture.

John Whitt, MD (retired)
Louisville Plastic Surgeon

Capsular contracture

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One theory of the cause for capsular contracture is low grade infections.  However, why it happens in one breast vs both no one knows for sure.  And no one knows for sure of the exact cause.

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

Capsular contracture - unilaterally

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Capsular contacture can occur on one or both sides at just about any time after surgery (I.e. Even many years later). We do not know for sure what causes capsular contracture, but the main going theory is that it is due to a biofilm caused by a low grade collection of bacteria, certainly not from activity of your dominant extremity. Healing is a continuum over a year or so. FYI, your body does not reject implants.

Todd C. Case, MD
Tucson Plastic Surgeon

Capsular contracture is not caused by activity, And your body CANNOT "reject" implants!

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Rejection is related to foreign tissue proteins in a host body (like a donor heart or kidney after transplantation, and requiring potent anti-rejection drugs for life). You do not and cannot "reject" implants of any kind, whether they be breast implants, pacemakers, or artificial hips! Also, if this was rejection, the same implant material is present in the same body on both sides, so it would stand to reason that both sides should become equally "rejected" and firm.

Any implantable device can become infected, broken, malpositioned, loose from their bony glue attachment. etc., but they are not rejected. Especially on one side only!

Capsular contracture is indeed caused by bacteria-induced biofilm formation on the surface of breast implants, and the bacterial contamination can occur from skin glands, hair follicles, or breast ducts (BTW, this is a hint as to why I believe that armpit and periareolar incisions have a higher potential for capsular contracture compared to inframammary incisions and submuscular placement).

Bleeding can either stimulate increased scar formation in and of itself, or may serve as "culture broth" for bacteria, but the end result is still increased capsule thickness and tightness (contracture). This COULD be a result of too much activity too soon.

Your increased right arm use could have caused a bit more bleeding, bruising, and consequent development of a more firm, thick, contracted capsule on that side. Or it may have simply been that more bacteria somehow were introduced into that side. Or both.

Since you're asking about time for healing, I will assume you are early after surgery. You may only have dissimilar swelling and firmness on one side over the other, rather than true capsular contracture. When contracture occurs, it generally becomes evident within the first few months after surgery, not the first few weeks. And, late unilateral capsular contracture can and does occur. I have seen this mostly in rare cases of minor breast trauma or injury coinciding with dental work (which causes a transient bacteremia that can be introduced around the implant, stimulating capsular contracture. This is why a few plastic surgeons--myself included--recommend antibiotics prior to dental work or other invasive procedures which might cause a bacteremia. Unfortunately, we're in the minority that recognize this).

You should reach maximum softness and your "final" result 6-12 months after surgery. If you are still early after surgery and have increased swelling and firmness on one side, you should see your surgeon and be checked for hematoma or seroma. This may not yet be a contracture. Best wishes!

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
4.9 out of 5 stars 263 reviews

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.