Capsular Contracture, Do Rates Vary a Lot from One Dr to Another? Is It Dumb Luck or Technique?

Im looking at doing a bl/ba I want a silicone implant. 2 of my friends have a Capsular Contractions. One at 8 months out in 1 breast, she passed on the recommended lift only implanted. The other right after surgery, in both breasts. She has said the implants were too wide to drop into the pocket. Is this based on Drs technique or a realistic risk?Her impacts are saline and 600cc does this up the risk? I would like a smaller implant placed under the muscle, will this lower my risk?

Doctor Answers 16

Capsular contracture

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Many factors can contribute to capsular contracture, including the type of implant, the position of the pocket, the incision site, and the surgeon's technique.  In my practice, I try to minimize the incidence of contracture in many ways- the incision under the crease of the breast has been shown to reduce the incidence of contracture over the incision around the nipple, so that is my preferred approach.  The implant position should be at least partially behind the muscle to reduce contracture.  I routinely use nipple shields and secondary skin sterilization to reduce the chance of infections, and also use a Keller Funnel with fresh gloves to provide an environment where the implant hardly touches any surface that could have contamination.  Placement of antibiotic fluid in the pocket may also aid in my low contracture rate.

You should ask your surgeon about what his or her thoughts are regarding preventing contracture- it is a very good and reasonable topic for discussion during your consultation.

Capsular Contracture

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This is a fantastic question.  The causes of capsular contracture are poorly understood, but technique clearly plays a role.  Although the exact cause is unknown, we believe that inflammation plays a role.  With meticulous surgical technique using an inframammary fold incision and subpectoral placement of the implant, antibiotic solution for the pocket, and "no-touching" of the implant, the capsular contracture rate can be brought very low. However, it is never 0%.  Choose your surgeon, carefully and quiz them about their's important.  Good luck.

Dustin L. Reid, MD
Austin Plastic Surgeon
5.0 out of 5 stars 86 reviews

Breast implant capsular contracture rate and implant size

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Breast capsular contracture rates, following breast augmentation, can vary with several factors including post operative bleeding, infection, implant size and surface texture, and position above or below the chest muscle.  You are correct that choosing a smaller implant and placing it under the muscle should help reduce these risks.  Also, if you choose smooth surfaced implants, check with your surgeon to see if/when they would suggest post operative breast massage, as this will also help to decrease the risk of a contracture.  Best wishes.

Vincent D. Lepore, MD
San Jose Plastic Surgeon
4.7 out of 5 stars 63 reviews

Capsule contracture after breast augmentation

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After more than 30 years and thousands of breast augmentations, here's my take on this issue. 

The body heals around a synthetic body like an implant by a layer of scar tissue called a "capsule". It is only called "capsule contracture" if the capsule thickens and contracts and confines/compresses the implant. The issue is why the body does this in some situations and not others including one side and not the other. The other problem is even defining what is capsule contracture and what isn't. It's not a simple thing that you either have or don't have. Often other problems are blamed on capsule contracture and too big an implant in too small a space is one of them. 

It seems as if the two most common irritants to a capsule that cause contracture are blood and bacteria. I can't prove it but I think my own and other's very low rate of capsule contracture is "no-touch" techniques to minimize the risk of bacterial or other debris around the implant and the use of the inframammary crease incision rather than peri-areolar incisions which serve to minimize the exposure of the implant pocket to the ducts in the breast tissue. Textured surface implants may work to prevent capsules from physically contracting and subpectoral placement of the implant may also help to separate the implant from the breast tissue. 

I wouldn't put too much faith in what you eat or what you do before a breast augmentation. 

Scott L. Replogle, MD
Boulder Plastic Surgeon

Capsular contracture

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There is very little agreement on why some patients get capsules while others do not.  I can tell you this much, the incidence with saline implants under the muscle is much less than with silicone implants.  If you want to reduce the risk of capsules, go with saline under the muscle and choose implants smaller than 600 cc's.  going with overly large implants has its own problems.

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 30 reviews

Capsular contracture , complications of breast implants, breast augmentation

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capsular contracture , complications of breast implants, breast augmentation

  • generally the rate will be about 10 percent.  some qoute lower.technique may play some part
  • combined procedures have more problems in general

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 116 reviews

Because of capsular contracture is unknown.

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The capsular contracture rate in the hands of qualified plastic surgeons is probably about the same. Since we really don't know the reason for capsular contracture and in uncomplicated case it's unlikely your surgeon, if he is skilled at this procedure, is the reason for capsular contracture.

Cause of Breast Capsular Contracture

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Breast capsular contracture can be either "dumb luck" or related somewhat to the surgical technique. The most common cause is a subclinical infection caused by bacteria on the surface of the implant Although this cannot be totally eliminated, there are techniques to markedly reduce the occurrence. While it is impossible to say whether your friend's capsular contracture was caused by technique, it is possible to say that the technique was not optimal. If the preoperative evaluation and technique were optimal, the implants would not have been too wide and they would have been placed properly to begin with and not have had to "drop into the pocket."

Robert T. Buchanan, MD
Highlands Plastic Surgeon

Causes of capsular contracture

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Capsular contractors are more likely with a submammary smooth surfaced implant than with a submammary textured implant. If you decide on smooth implants, they should be placed under the muscle. I personally believe that larger implants have a higher complication rate in general and agree that going smaller and under the muscle will mitigate the risk. Capsular contracture is one of the most common complications than can arise from augmentation and definitely warrants serious discussion with patients.

Capsular Contracture, Do Rates Vary a Lot from One Dr to Another? Is It Dumb Luck or Technique?

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      Capsular contracture can occur in even the most careful surgeon's practice, and we do not know everything that is responsible for the occurrence of capsular contracture.  The most important thing in this consideration is to find a plastic surgeon who does hundreds of breast augmentations and revisions who is very sophisticated in the approach to treating capsular contracture should it occur.  Kenneth Hughes, MD Los Angeles, CA

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.