How and when does capsular contracture happen?

That is the million dollar question that no one has the answer to.
There are many theories for why this happens. It can occur almost immediately or happen many months later. It can affect one or both breasts.
People have attibuted this to wound healing, infection, and/or minor bleeding.
Probably the most widely held theory is related to any implant and popular thought attributes this to a biofilm that develops on the surface of any prosthesis. This is actively being studies as it relates to implants used in many fields of medicine such as orthoedics, cardiac surgery, dental surgery, urology, plastic surgery, etc.
A biofilm is a layer of bacteria with their associated excreted proteins that forms a layer over the surface of the implant. The bacteria become dormant and somewhat resistant to normal doses of antibiotics.
This is somwhat similar to the shiny slime that develops on a rock in s stream. Despite the cleansing action of the stream the slime remains on the rock.
The bodies response to the biofilm (sometimes called bioslime) results in some of the complications associated with implants including capsular contracture.
Studies are currently being aimed towards preventing adherence of the bacteria Others are trying to figure out how to dissolve the fim which is very resistant.
Prevention with use of antibiotics and a minimal touch/handing is one of the best methods to minimize development of the biofilm. Once developed, the only tried and true method is to replace the implant or remove it entirely as well as remove an established capsular contracture.
This is the prevailing theory. This is a very cursory review of a very complex subject and is clearly not all inclusive nor definitive.
I hope this helps.

I'm sorry to hear about the issues that you are experiencing. If you continue to have recurrent capsular contractures, I would recommend implantation of the material called Strattice. This is an acellular dermal matrix that helps prevent recurrence of capsular contractures. I would recommend reaching out to your plastic surgeon to discuss this option.

Hello! Thank you for your question! Physical examination will determine if you have capsular contracture. The look and feel of hardness surrounding your implant is seen and/or felt. At its worst, you experience pain. It may also cause distortion of your breast. What has caused it is still in question. Most will develop within a year postop. Your surgeon will likely recommend implant massage and may add the medication Singulair. If these fail, surgical correction may be suggested. It is a matter of surgeon preference as well as what is seen during your procedure that will determine whether or not a complete capsulectomy is performed. If significant capsule formation is seen intraoperatively, a full capule removal may be warranted with a drain in order to completely remove all of the tissue and allow better adherence of your breast back to its normal anatomic position down on your chest wall. Irrigating with certain medications may also be if benefit. If minimal contracture is seen, it may be possible to leave the capsule, or place cuts within the capsule to allow better adherence. It truly is dependent on what is seen with your capsule and the issues that may be causing you to have such a procedure (e.g., contracture from rutptured implant vs pain vs simple pocket adjustment, etc). Without knowing your issues and without an examination, it is difficult to tell you what may be the best thing for you. I tend to favor performing capsulectomies in order to create a fresh pocket, reshape the pocket, allow better shape and adherence of the overlying breast. I would discuss your issues with your plastic surgeon who will assist you in determining the right modality for you. Hope that this helps! Best wishes!