How and when does capsular contracture happen?

Question

I have breast implants and my right breast keeps getting Capsular Contracture. How and when does this happen?

Otto Joseph Placik, MD · Answer

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.

Austin Hayes, MD · Answer

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.

Lewis Albert Andres, MD · Answer

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!

Michael Law, MD · Answer

When a woman experiences capsular contracture it is not the implants themselves that turn hard, of course; what has really happened is that the fibrous capsule around the implants has tightened and thickened, making the implants less mobile and causing them to feel firm (and eventually, in some cases, even 'hard'). The medical term for this phenomenon is 'capsular contracture'. It is a problem that is best managed by avoiding it altogether, and fortunately there are a number of things that can be done on the day of surgery to guard against it.

	Any time a foreign object is implanted in the body, whether it is a pacemaker or a breast implant or an orthopedic device or anything else, the body responds by forming a thin, wispy, fibrous membrane around it. In most cases this membrane or 'capsule' stays thin and wispy, but in some cases over time the capsule may tighten around the implant and thicken, making the implant feel firm or even hard. In advanced stages the contracted capsule can even distort the shape and position of a breast implant. Capsular contracture can be treated, but it is a surgical treatment, so avoiding capsular contracture is all about avoiding another trip to the operating room.

	Capsular contracture can occur on one or both sides, and while it can develop early (weeks) or late (years) after a breast augmentation surgery, in the vast majority of cases it is evident fairly early following the procedure. So the good news is that once you are six to 12 months out from your surgery, if your augmented breasts are soft and supple then they are likely to stay that way for the long term.

	It is believed that capsular contracture is primarily a response to the presence of low-virulence or non-virulent bacteria (i.e. not the kind that generally produce an actual infection, with redness/tenderness/fever etc) that adhere to the implant surface on the day of surgery, and which over weeks and months following surgery stimulate the cells that make collagen (called fibroblasts) to make more collagen - thickening the capsule and stimulating it to contract and tighten around the implant. It is not an actual infection; there are no symptoms that this is going on, and taking antibiotics will not prevent the process or reverse it. The source of these non-virulent bacteria is thought to be the patient's skin, or the ductal systems of the breast that lead to the nipple, as both are normally colonized with bacteria.

	Because plastic surgeons now have an understanding of some of the reasons why capsular contracture occurs, there are a number of measures that can be taken to significantly reduce the likelihood that it will happen following breast augmentation surgery.

Sam Speron, MD, FACS · Answer

Hi,
Thank you for your question!
During your surgery, a pocket was made in your breast for the implant. When breast implants are placed into the body, a lining or capsule of tissue forms around the implants as you heal. This is your body's natural response to a foreign object. Usually, the pocket will stay open and the capsule stays soft. However, our body will sometimes want to shrink the "scar" tissue, which is what occurs during capsular contracture. The capsule tightens around the implant, causing it to look differently and feel hard. 
It is uncertain when and why this happens, but it is more common in the first couple months after surgery. However, capsular contracture can happen at any time. You may have a higher risk of contrature following an infection or if the implant shell has been exposed to bacteria. Placing the implant above the muscle as opposed to behind the muscle, also has a tendency to put you at a higher risk for capsular contracture.
I hope this helps.

Shahram Salemy, MD, FACS · Answer

Some folks will develop contracture despite our best efforts, and as long as your surgeon is replacing your implants with new implants, removing the entire capsule, putting on an antibiotic regimen and a massage plan after the procedure, and being meticulous with control of bleeding, everything that can be done is being done. There may come a point then that you will have to decide how bad the contracture bothers you and if you want the implant removed permanently.

Christopher L. Hess, MD · Answer

Why capsular contracture happens we don't really know.  But we do know that there are things that can potentially cause it and things that decrease its incidence.  Previously various medications such as antibiotics and other sterilizing agents were used to irrigate the pocket prior to implant placement.  These have been found to cause irritation and capsular contracture.  
When the capsular contracture happens is another questions but typically it is a delayed phenomenon, perhaps years.    But the reality is that it is seldom seen nowadays since we have been putting implants under the pectoralis muscle.  So don't worry about it.

Steven Wallach, MD · Answer

That is a great question. No one knows for sure why it develops. There are a lot of different theories. One of the more popular ones relates to the notion of a subclinical infection leading to a gradual capsular contracture.

Richard P. Rand, MD, FACS (retired) · Answer

Please read Dr. Placik's excellent review of capsular contracture etiology and treatment. When your body shows that capacity to make a capsular contracture, it can continue to do this on a repeated basis despite all measures to the contrary.  
Basically you need to make sure that your surgeon has removed all of the capsule and replaced a new implant in the pocket.  If your implants were above the muscle, they should be moved below the muscle.  Taking Vit E after surgery and a vigorous massage program can sometimes halt the development of future contractures.  In the end, if nothing works, you will need to decide if it is bad enough to be willing to have the implants removed and left out.

How and when does capsular contracture happen?

Answers (9)

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