Does working out hard create capsular contraction?

Thank you for sharing your excellent question and I hope your recovery goes smoothly.  Working your chest muscle does not pose an increased risk of capsular contracture formation and you should be able to return to your former activities without issue.  The leading thoughts on capsular contracture indicate that bacterial colonization of the tissues/implant are the cause of the scar tissue hardening.  Hope this helps.

Although it can be difficult to pin down the exact cause of capsular contracture, what we do know about the causes of capsular contracture does not indicate the exercise would increase your risk. That said, if your plastic surgeon has recommended that you avoid strenuous physical activity for the next few weeks, it’s important to heed that advice. As for working out in the future, though, this shouldn’t be a problem.

In a word no.  Fit people have very little fat to hide capsular contracture or implants.  At times repeated capsular contractures are addressed with acellular dermal matrix (tissue)  to try and prevent further contractures.