Silicone Implant Contracture: Is It the Patient's Fault?

I had saline implants for 10 years then one leaked (due to defective valve), deflated quickly, and encapsulated, so I had them both replaced with silicone. Now, a year later, i am experiencing swelling near my armpit, tenderness, and a small fever. My breast on this side has begun to itch, get smaller, and hard, while the other remains fine. my doctor says it is my fault for not massaging them everyday for the rest of my life, and it is a contracture. Is this really all me?

Doctor Answers 19

Capsular Contracture is Usually Not Anyone's Fault

Capsular Contracture is thought to be due to many reasons, and possibly a low-grade infection or hematoma.  Implant massage is pretty standard for patients to do post-surgery, but it's not known how important it is to do this to prevent capsular contracture.  I would recommend a 2nd opinion or 3rd opinion before deciding if you need more non-surgical treatment or surgical revision.

San Francisco Plastic Surgeon
4.2 out of 5 stars 6 reviews

Capsular contracture is no one's fault

Some patients have the propensity to form breast capsules and insufficient scientific data exist at this time to clarify why this is the case. The condition you describe may or may not be evidence of a capsular contracture. There is no evidence that failure to massage the implants is the primary causative factor in capsule formation.

Robert L. Kraft, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 40 reviews

Is never the patient's fault

there are many potential causes for capsular contracture and it is a poorly understood problem.  It is inappropriate  for anyone to blame the patient for this problem.  The goal should be to try and find the solution and make things better, not blame.

Peter D. Geldner, MD
Chicago Plastic Surgeon
4.6 out of 5 stars 28 reviews

Breast Augmentation and Encapsulation

Thank you for the question. 

Encapsulation is the  process  of exuberant inflammatory tissue/scar tissue that builds up around a breast implant. It is unknown why some patients develop this process and others don't. Although there are a lot of “theories”, there is no science that is definitive when it comes to causation.

Placing blame or fault is not appropriate and/or helpful.

Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,487 reviews

No evidence that massage works

The concept of massaging breast implants works in theory, not necessarily in practice. There is absolutely no scientific evidence that implant massage prevents capsular contracture. Sadly, some surgeons will do as yours has done and use 'inadequate massage' to blame their patients for capsular contractures. It is wrong and unethical. I suggest that you find another surgeon.

James McMahan, MD
Columbus Plastic Surgeon
4.8 out of 5 stars 38 reviews

Capsular contracture...Who is at fault?

The answer to this question is no one!  We do not really understand capsular contracture its causes or its prevention. What we know is that capsular contracture occurs and it is impossible to predict when and in whom it will occur. I recommend you find a surgeon you are comfortable with and have a discussion of this problem and its possible solutions. As you are having recurrent contractures I would also recommend that you discuss an acellular dermal matrix product such as AlloDerm or Stratice during your consultation.

Paul Vitenas, Jr., MD
Houston Plastic Surgeon
4.8 out of 5 stars 109 reviews

Capsular contracture is not a fault of the patient.

Capsular contracture is a common occurrence after breast augmentation and a process which is poorly understood. There are several known risks to developing contracture including hematomas, infections, and radiation. However, most contractures appear to be idiopathic - meaning we do not know the cause. They are often one-sided and can recur several times. Some surgeons recommend massage and others do not. Simply removing the capsule and replacing the implant is an effective treatment for many patients. In refractory cases, the addition of acellular dermis (Alloderm or Strattice) to the augmentation seems to deter capsule formation and thus circumferential contracture, however this is a very expensive treatment option. The goal now should be proceeding to treatment rather than assigning blame.

David Bogue, MD
Boca Raton Plastic Surgeon
5.0 out of 5 stars 25 reviews

Capsular contracture-it's not your fault

The cause of capsular contracture is not fully understood but it's felt to be due to an inflammatory process that develops due to microbacteria coming into contact with the breast implant. This bacteria can come from the breast tissue itself. Some patients just develop an exuberant inflammatory reaction to the implants and form thick, hard scar tissue (capsule). Most surgeons will coat the implant in an antibiotic solution to help minimize this risk.  Also placing the implant under the pectoral muscle can help minimize the risk of capsular contracture. Regardless of what you or your surgeon does, the risk of developing capsular contracture is about 10%. We do know that smoking increases your risk, so you should not smoke before or after your surgery. 

Although massaging your implants can help, it does not necessarily protect you from developing this condition.  I usually have patients take high doses of vitamin E and sometimes Singulair-an asthma medication which is a potent anti-inflammatory drug which can help control/minimize the development of scar tissue.

Please consult with your plastic surgeon regarding treatment options for capsular contracture.

Best wishes,

Dr. Bruno

William Bruno, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 377 reviews

Capsular contractire in 1 year old silicone implant replacing 10 year old saline implants.

There are numerous factors that contribute to capsular contracture formation with biofilm formation being one of the most popular explanations. It is difficult to pinpoint the cause for your capsualr contracture  in your description.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 81 reviews

Capsular contracture

Capsular contractures are thought to be caused by many different things. There is no scientific support of massage and the avoidance of a capsular contracture.  It may be multifactorial. There may be a genetic component, or  an infectious cause to name a few.  It is thought to be associated with hematomas as well.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 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.