Will capsular contracture happen to me again if I use a smaller implant?

Capsular contracture is a frustrating part of breast surgery
that can occur in a small percentage of patients. The reasons for capsular
contracture can vary. However, a few major themes are present and often
capsular contracture can be due to multiple factors. A common feature seen is
capsular contracture is the presence of a biofilm which is a small amount of
bacteria that can collect on the surface of the implant. The body tries to
clear the bacteria; however, it is unable to clear it due to the presence of a
foreign body (the breast implant). The result is an inflammatory reaction that
occurs which causes the body to tighten and potentially thicken the scar tissue
around the implant tightening the breast and creating a hardened appearance or
a firmer feel to the implant. A solution to this is generally to remove the biofilm,
which entails removing the implant and replacing it with a new implant and
removing the old capsule and washing the pocket out with antibiotic washes.I also frequently use an acellular dermal matrix called Strattice,
which can help to reduce the risk of recurrent capsular contracture. One of the
causes of capsular contracture can include trauma to the breasts particularly
when there is the presence of blood in the breast pocket, which can also
trigger more inflammation of the body. Size of implants does not have a major impact on capsular
contracture rates. Some studies have shown that larger implants are actually
somewhat lower risk for capsular contracture. However, I do not feel that
implant size should be taken as a significant consideration when dealing with
capsular contracture. Breast implant size should be appropriate to the base of
the patient’s body dimensions. One major factor specific to capsular
contracture is location of the implant placement. If the implant is placed
above the muscle, the patient could be at higher risk for capsular contracture
whereas if the implant is placed under the pectoralis major muscle the risk is
lower. Likewise, textured implants can reduce the risk of capsular contracture
particularly when the implant is in the subglandular (over the muscle)
position. If you have had an issue with prior capsular contractures
and are seeking treatment of this, I would make sure that you are working with
an experienced Board Certified Plastic Surgeon and you should consider complete
capsulectomy, implant exchange and possibly the use of an acellular dermal
matrix to lower your risk of problems in the future. Best of luck!

Thank you for your question.  Because you have had repeated capsules, you are at high risk for recurrence.  I have found that the use of smaller implants may help, but Strattice ADM (acellular dermal matrix) has been nearly miraculous for my patients with a tendency toward recurrent capsules.  It is important that you replace your existing implants with new implants, have a capsulectomy peformed, and although costly, seriously consider placement of Strattice ADM.  It works extremely well in preventing recurrence of capsular contracture.  You didn't mention if your implants were subglandular or submuscular but submuscular placement is optimal for reducing the risk of capsular contracture.  I would recommend seeing a few board certified plastic surgeons to discuss your options in more detail.  Best of luck to you. 

Plastic surgeons still don't have a good handle on why some patients develop capsules while others do not.  Switching to a smaller implant combined with removal of the old capsule may solve the problem, maybe not.  Unfortunately there are no guarantee that a disuse won't recur once it has happened.  Can be very frustrating.  I'm not a huge fan of acellular dermal matrix.  At that point, it becomes very costly and maybe removal of implants altogether is something to consider otherwise you could be dealing with the problem for years to come.