Capsular contracture - how quick can you usually tell if this is going to happen or not?

I had breast Augmentation 2 days ago,310cc ultra high profile over the muscle and worried about capsular contracture, how quick can you usually tell if this is going to happen or not?

Doctor Answers 5

Capsular contractures

You begin forming a capsule around an implant as early as a week out from surgery.  As long as the capsule remains thin and pliable it is no problem.  It is only when the capsule thickens or contracts that the breast can become firm or distorted.  Capsules can run the spectrum from really soft to rock hard. Capsular contractures are not dangerous.  It is only when they are a problem for you that they are a problem at all.  Patients generally complain if their breasts become too firm or look distorted or if one breast is firmer than the other.  Capsular contractures are also more common when implants are above the muscle than when they are under the muscle.  Many people attribute this to the presence of bacteria which live within the breast tissue.  When implants are placed above the chest muscle, the use of textured surface implants may decrease your risk of capsular contracture over smooth implants.  When placed under the muscle, it doesn't really matter which implant is used.


Atlanta Plastic Surgeon
4.8 out of 5 stars 24 reviews

Capsular contracture - how quick can you usually tell if this is going to happen or not

Thank you for your question. There is no definite answer for your question. It widely varies. It is not common within 6 months. Right now please follow instructions from your PS and follow up regularly with your physician. Please express your concerns to your PS

Concerns over capsular contracture 2 days postop

Thank you for your question!

In general, capsular contracture (CC) can occur at any time, but most cases are documented in under 12 months (i.e., anywhere from 3 months to 12 months post operation). This is because it takes time for the fibrous tissue capsule to form around the implant, and then it will have to scar down (contract).

Nevertheless, CC can start early when there is significant bleeding or infection or another co-existing problem.

Now regarding your concerns, because you had 310 cc ultra high profile over the muscle, the breasts will feel firm and tight which is common with capsular contracture. However, such tightness is just because the breast tissue and skin have not adopted to the implants yet. With effects of gravity and healing, the breasts will feel more natural and soft as time goes.  

Now I need you to know that there are 4 grades/levels of capsular contracture:

  1. Grade I — the breast is normally soft and appears natural in size and shape.
  2. Grade II — the breast is a little firm, but appears normal.
  3. Grade III — the breast is firm and appears abnormal.
  4. Grade IV — the breast is hard, painful to the touch, and appears abnormal.


If your breasts do not appear abnormal, tight, firm, or painful, then you are fine and shouldn’t not be concerned, especially because it has only been 2 days.

Now, grades 1 and 2 CC do not require surgery, and can be fixed with breast massaging and singulair.

Massaging will keep the naturally occurring capsule stretched hindering it from contracting. However, this should not be done excessively as you may further aggravate the breast pocket causing inflammation.

If all these treatments fail, then surgical correction is your next option. There are two methods for surgical correction: removing the capsule (capsulectomy) and releasing/tearing the capsule (capsulotomy).

In terms of what can and cannot cause capsular contracture, we can refer to a recent literature review by Dr. Chong & Dr. Deva titled Understanding the Etiology and Prevention of Capsular Contracture.  This clearly outlines what can increase and decrease the chances of capsular contracture and all things are ultimately related to implant contamination.
  • Initiators:
    • Bacterial Infection
    • Periareolar incision (natural bacteria of the breast can contaminate the implant during insertion)
    • Subglandular pocket (same reason as above)
    • Prolonged exposure of the implant to the surrounding surgical environment (lack of sterility in the surgical environment can cause contamination of the implant
    • Hematoma (blood can increase inflammation and speed up fibrous capsule formation)
    • Use of drains (increase risk of infections by 5 folds, and thereby increase risk of CC)
  • Suppressors:
    • Avoiding large implants (large implants can easily be contaminated)
    • Textured implants with submammary pocket (Textured implants may not help in the submuscular pocket)
    • Submuscular pocket (the implant is not exposed to breast’s natural bacterial flora)
    • IV antibiotics
    • Washing the implant pocket with antibacterial solution
    • Using insertion sleeves (i.e., Keller Funnel) for the implants (reduces contact with bacteria)


That being said, you can also help prevent a capsular contracture by having regular follow-ups with your surgeon to make sure your breasts are healing beautifully.

Hope this helps

Martin Jugenburg, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 427 reviews

Capsule

At only 2 days from surgery, you should not be concerned about capsular contracture. Please follow your surgeon's post operative instructions, and keep all your follow up visits. Your surgeon will keep an eye on your progress.

Connie Hiers, MD
San Antonio Plastic Surgeon
4.6 out of 5 stars 13 reviews

Capsular contracture - how quick can you usually tell if this is going to happen or not?

Thank you for your question.  Unfortunately there is no standard answer to your question as capsular contracture requiring surgical revision is an on-going possibility with any implant, developing within months of surgery or years down the line.  What is most important is to be vigilant about any significant changes to the appearance or feel of your implants and reach out to your surgeon as these present themselves. 

Nelson Castillo, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 43 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.