When doctors try a different breast implant size during surgery, will that increase capsular contracture?

Question

Cause if bacteria going inside?

Semih Yildiz, MD, FEPOBRAS · Answer

Trying a different implant size during surgery usually means the surgeon is using sterile implant sizers or a sterile trial implant inside the pocket. When this is done with proper sterile technique, it is a normal part of breast augmentation and does not automatically mean a higher risk of capsular contracture.

Bacteria contamination is one possible factor in capsular contracture, but surgeons reduce that risk by using sterile sizers, changing gloves, limiting implant handling, preparing the skin carefully, irrigating the pocket, and using no-touch techniques when appropriate. The bigger issue is not simply that a size was tried; it is whether sterility, hemostasis, and careful pocket handling were maintained. If you are concerned, ask your surgeon what steps they use to reduce contamination and capsular contracture risk.

Steven Sigalove, MD FACS · Answer

Capsular Contracture is most likely caused by biofilm which is the result of bacteria entering the pocket and colonizing the surface of the breast implant. During surgery, most board certified plastic surgeon who specify in aesthetic breast surgery will use what is called a no touch technique which minimizes bacterial inflow to the pocket. Use of antibacterial and irrigations, use of a no touch delivery device, use of antibiotics, change of gloves, and multiple other technical things will minimize the risks of capsular contracture. Even when sterilized sizers are used, a Keller Funnel is always used again minimizing the risks of bacteria entering the pocket. So in answer to your question, when multiple sizers for implants are placed in to the pocket, as long as an antibacterial, no touch technique is utilized, the risks of capsular contracture are not increased.

Daniel Barrett, MD · Answer

Dear rainrain90,
capsular contracture happens. In fact, every implant has a capsule form around it, its just a certain percentage develop thick capsules. There is a lot we don't know about it actually. Some think that bacteria that gets on the implant during insertion can increase the risk. Thats why we use a Keller Funnel in our practice to reduce that possibility. Our capsular contracture rate is less than 2% because we use a keller funnel as well as meticulous operating room techniques.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Leila Kasrai, MD, FRCSC · Answer

Any implants that are placed inside a patient’s body should be sterile and typically, only one implant is placed rather than “trying out” different sizes. The size is determined before surgery.

Miguel Mota, MD · Answer

Hello and thank you for posting. No. This does not increase chances of a capsular contraction. Infections or hematomas or even too much trauma during surgery may increase the chances of a capsular contraction, but testimony out diferente sizes during surgery does not. Implants are sterile there there is no reason for bacteria to go inside the pocket.

Best of luck,
Dr. Miguel Mota

Best of luck,
Dr. Miguel Mota

Finny George, MD · Answer

Hi, thank you for sharing your question. After the implant sizers are placed, the breast pocket and skin are cleanse again with antibiotic solution and the surgeon changes their gloves. This combination of steps minimizes the bacterial exposure.

Zoran Potparic, MD · Answer

In most cases when evaluating volume of the implant intraoperativly, surgeon would use implants sizer. This is sterile, brand new, silicone bag, made in the shape of implant; placed in the implant pocket and inflated with air or saline it allows a surgeon to try different volumes by adding or removing air/saline, without acturally changing the implant. Once desired volume/shape is achieved, surgeon removes sizer, irrigates the posket with antibiotic solution and places implant of the similar volume/style. So, there is only one implant change during procedure. We do not have scientific data to show that this management increases the risk of implant related breast contracture. Hope this helps. Good luck.

Camille Cash, MD · Answer

No, using sizers should not increase the chance of capsular contracture.  The implants are sterile, the technique is sterile, and the pocket is cleansed with antibacterial solution.  These are just a few of the many steps that I take to help keep the occurrence of capsular contracture of my patients to a minimum.

Connie Hiers, MD, FACS · Answer

No, even if a sizer or a couple of different sizes are used, the implants are all sterile. Plus, the pocket is irrigated with a antibacterial solution prior to placing the implants.

Mark T. Boschert, MD · Answer

This is very insightful question.. However, the very minimal manipulation for placing a sizing implant should have a little risk for increasing capsular contracture. The reasons for capsule contracture are most likely due to an inflammatory causative agent left in the pocket after completion of the procedure. This is why most surgeons today will only touch the permanent final implant after changing an outer pair of gloves, and either placing it carefully or using some sort of funnel to put the implant into the pocket. Only after the pocket has been thoroughly irrigated and cleaned of any potential irritant, such as blood or bacteria. also, the sizer implants are inflatable and are sterile that can be placed with a little touching of the skin and inflated with air or water, so as to barely touch or irritate the outside of the wound edge. In any case, this is one point I would not worry about. It is better to look at the experience and the board certification of your plastic surgeon. Best of luck! Dr. Boschert. Renaissance Plastic Surgery, Saint peters, Missouri.

When doctors try a different breast implant size during surgery, will that increase capsular contracture?

Answers (11)

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