Querying whether any pre-existing medical conditions predispose a patient to capsular contracture post breast implants?

What autoimmune diseases predispose a patient (if any do), to capsular contracture post breast implants & have there been any published studies done comparing the use of the Keller Funnel for implants vs. standard touch-technique? Thank you.

Doctor Answers 2

Querying whether any pre-existing medical conditions predispose a patient to capsular contracture post breast implants?

No medical conditions that I am aware of predispose you to capsular contracture. Technique is most important in addition to not leaving blood in pocket. I use Keller funnel religiously and believe it helps the no touch technique but no study I am aware of yet that proves benefit.

Capsular contracture

Thank you for your question!

In breast augmentation, capsular contracture refers to tightening of the scar tissue that normally forms around the implants resulting in hardened, painful, and abnormal looking breasts with varying degrees of severity. Below I describe the classification system for capsular contracture.

Grade 1 – breast is normally soft and appears natural in size and shape

Grade 2 – breast is a little firm, but appears normal

Grade 3 - breast is firm and appears abnormal, there is no pain

Grade 4 – breast is hard, painful to touch, and appears abnormal


Only grades 3 and 4 requires a surgery.


If you have had a fever, and if you know whether the fever was because of a bacterial origin, then taking antibiotics is important. You have to realize that capsular contracture occurs due to bacterial contamination and inflammatory environments near the implant. Usually an infection near the incisions can cause inflammation in the breast pocket and aggravate the capsule (fibrous tissue) that forms around your implant.

Now, most of the preventative measures are taken in the surgical environment (i.e., administering of IV antibiotics, washing implant pockets with antibiotic solution, using the Keller funnel to insert the implant without contamination, avoiding use of drains, using electrocautery to prevent bleeding and hematoma, using nipple shields to cover up potential contamination areas, and minimizing air exposure of the implant).


The literature review by Dr. Chong & Dr. Deva titled Understanding the Etiology and Prevention of Capsular Contracture, 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)

These are the only things research has shown to influence the risk of capsular contracture.

In the context of using the Keller Funnel, it has been noted in literature that the funnel can result in a 27-fold decrease in skin contact for most implants (the study used implants between the sizes 300-600 cc). It was also noted that bacterial contamination was two times more likely with the standard touch technique, which is why it is beneficial for use. In the 1993 study by Mladick, it was shown that when no-technique is used infections did not occur at all, and the rate of capsular contraction went down to 0.6%.

In the end, your outcomes depend on your surgeon's surgical skill and technique. Make sure to choose a surgeon you can trust. Your surgeon should be someone who does not rush you, and someone who does not agree to everything you say because safety should be the first thing on their mind. Clearly, you wouldn’t know what is best for you, so they should guide to make decisions that will minimize complications and allow you to have beautiful breasts in the long-term.

Verify their skills, education, and certification. Ask about your surgeon’s experience about the procedure you want and ask to review photographic examples of your surgeon’s work. Check to see if the aesthetic ideal is consistent with what you are hoping to achieve. Please make sure that you look at pictures of patients who had the same pre-operative breast characteristics that you display. Also make sure the before and after images have the same perspective, the same lighting.  Read the surgeon’s reviews for the procedure you want.

Please book an in-person consultation with a board-certified surgeon and make sure to fully and comprehensively share your desires, expectations, and concerns.

Hope this helps.


Martin Jugenburg, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 425 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.