Can Capsular Contracture be prevented? What causes it to happen?

Doctor Answers 15

Capsular contractors can be eliminated

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Capsular contractors cannot be eliminated. Techniques to prevent then are submuscular position, cover nipple with a barrier, change to non-powdered gloves when handling implant, absolute control of bleeding and using a sterile barrier to prevent the implant from touching the skin.  These techniques go a long way in reducing the problem. 

Prevention of Capsular Contracture

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The short answer is no, it cannot be prevented and no one knows for sure what causes it to happen. Many theories have been considered. Most recently a subclinical low-grade infection with staph aureus resulting from a mono layer of bacteria around the implant. Certain steps can be taken to lessen its occurrence however, placing the implant under the muscle rather than over the muscle seems to help.Meticulous control of bleeding at the time of operation also seems to help, and with this in mind, one of my preferences is always to use a drain to evacuate fluid from the pocket, although many surgeons do not do this.

Prevention of capsular contracture

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Unfortunately, capsular contracture after breast augmentation cannot be completely eliminated. However, an experienced surgeon can do a number of things to minimize the risk such as less handling of the implant before placement by using a Keller funnel, making sure there is a sterile environment and changing gloves before handling the implant, and sometimes, the choice of implant used can make a difference. Some people believe that the friction caused by movement of the implant can add to the risk, so we advise our patients to take it easy and refrain from vigorous activity during the post operative period. 

Can Capsular Contracture be prevented? What causes it to happen?

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Thank you for your important question. After many years of research we still do not fully understand why causes capsular contracture. Certainly wound contamination, excess blood and that implant pocket both can be significant contributing factors.

Although we cannot totally eliminate capsular contracture the rate of capsular contracture has been reduced from nearly 40% in the 60s and 70s to 4.3% today which is in almost tenfold decrease.

Techniques that can reduce capsular contraction are the no touch technique, which prevents contamination of the pocket and which also includes use of the Keller funnel, the new cohesive gel silicone implants, submuscular location of implant when possible, very careful fastideous surgical technique, and in my opinion the institution of breast implant displacement exercises soon after surgery. If there is indication a capsulitis forming the use of the medications Singulair can also be helpful.

Capsular Contracture: Information

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Dear Ms. lanisa91,

Thank you for your questions.

Prevention of capsular I believe has three parts:
1) sub muscular placement
2) use of textured implant (has other limitations)
3) access incision: inframammary (breast crease)
4) intra operative contamination:
A) changing non powdered gloves prior to insertion (use of Keller funnel)
B) physical skin barriers (op site over breast and incision site)
C) minimal touching of implant
5) intraoperative irrigation of breast pocket with a antibiotic solution
6) pre and post surgical antibiotics
7) gentle handling of tissue
8) precise hemostasis (no blood left behind)

1) Antibacterial scrub of breasts night before and morning of surgery
2) avoidance of any smoking (first or second hand)
3) regular displacement exercises of breast implants
4) limited antibiotic coverage for future major dental procedures or surgery.
5) avoidance of medications that can lead to bleeding after surgery
(Aspirin, Motrin, Alleve , etc)

1) certain individuals can do all of the above a still acquire a capsular contracture.
2) certain individuals can skip all of the above a not acquire a capsular contracture.

1) unknown 
2) contamination? Resulting Biofilm
3) Genetics
4) residual blood in pocket for matrix of scar to form on.

Capsular contracture incidence is less but still a vexing problem when it occurs.ll

I recommend that you make several consultative appointments with Plastic Surgeons who are experienced and Certified by the American Board of Plastic Surgery. In addition ideally they are members of the American Society for Aesthetic Plastic Surgery (denoting by membership as having met additional criteria and a focus on Cosmetic Plastic Surgery).

I wish you my best and success,

R. A. Hardesty, MD, FACS
Diplomate and Certified by the Am. Bd. of Plastic Surgery
4646 Brockton Ave
Riverside, Ca 92506
(951) 686-7600

Capsular Contraction can be minimized but not completely prevented

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The cause of capsular contraction is thought to be most frequently caused by a Biofilm which is a film of bacteria around the implant, usually Staph Epidermitis. Staph Epidermitis is a non pathogenic bacteria which lives harmlessly on almost all people. So with this knowledge a plastic surgeon can minimize the frequency of Capsular contraction by meticulous surgical detail. The breast pocket should be carefully checked for any bleeding, washed out to remove any foreign debris. The pocket should be filled with a triple antibiotic solution of Ancef, bacitracin, gentamicin and marcaine. The implant should be coated in the same solution. The surgeon should then change their surgical gloves and touch only the implant and prevent it from touching the skin by inserting it with a Keller Funnel. The average Capsular contraction rate with Mentor textured implants is reported at 14%. I have been fortunate to have lowered this to 0.7% in my practice by using this technique. Interestingly I also alway put the implant in through a peri areolar incision and then place the implant either under just the breast if the patient have enough soft tissue cover in the upper pole of the breast, and under the breast below and the muscle above (Dual Plane) if not enough soft tissue in the upper pole. I also feel I get superior results with a high profile textured Siltex Mentor gel filled implant. I hope this gives you some insight into the cause and the minimization of Capsular Contraction. 

Capsular Contracture

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There are a number of theories on what causes capsular contracture. No one really knows for certain however there are certain techniques that can lower your risk such as placing the incision in the breast fold, and the implant under the muscle. 
My best,
Dr. Sheila Nazarian
@drsheilanazarian on Instagram

Capsular contracture

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Capsular contracture in primary breast augmentation is a very rare problem, in my hands.  It is associated with hematoma and low grade infection, and therefore is more dependent upon surgical technique than anything that the patient does.

Can I prevent capsular contracture?

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There are many theories as to what causes capsular contracture and many of today's techniques try to prevent it - such as using an incision in the fold, placing the implant under the muscle, and bathing the implant and pocket in antibiotics. In many patients it is not known why they develop capsular contracture (and if you think about it .. why does it usually only happen on 1 side and not the other??). I would recommend a formal consultation with a board certified plastic surgeon where your concerns can be gone over in detail. Good luck!

Bryan Correa, MD
Houston Plastic Surgeon

Breast augmentation - avoiding capsular contracture

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Thank you for asking about your breast augmentation.
  • Yours is an excellent question and one that has been the subject of much research.
  • As best as we can tell, capsular contracture is the body's natural response to any object that irritates the internal tissues.
  • A common cause of irritation is a biofil - a layer of bacteria over the implant that isn't enough to cause a serious infection but will cause chronic irritation.
  • A biofilm can occur at surgery - we take extreme precautions to keep bacteria away from the implant.
  • But it can occur if you have an infection somewhere else - and bacteria get in the blood stream and settle on the implant.
  • Another cause is the implant material - gel implants seem a bit more irritating than the saline ones.
  • Another cause appears to be sleeping position - women who hug a breast during sleep are likely to get a capsule on the side they hug!
  • Overall, the risk of a capsule is 1% a year, every year.

Always see a Board Certified Plastic Surgeon.
Hope you find this information helpful. Best wishes.

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.