What Are the Chances of Capsular Contracture?

           I perform about 500 breast augmentations each year, and I can count the number of capsulectomies I performed in the last year on one hand.  The risk is definitely less than 5%, but the number may be smaller than that.  Find a plastic surgeon with ELITE credentials who performs hundreds of breast augmentations each year.  Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results.  Kenneth Hughes, MD Los Angeles, CA

Most studies show rate of severe capsular contracture at 2-10% in cosmetic breast implant patients.  For breast reconstruction the rate is likely higher.  Ask your surgeon, but personally I believe the chances are lower if the implants are placed "under the muscle".  Best of luck to you.
 

from having an augmentation.  Life is about living and if larger breasts will make it much better for you, go for it.  Certainly risks for contractures can be reduced by surgeon technique and some are better than others.  But its really difficult to find that out.  If you do proceed, and are unfortunate enough to develop a contracture, try once to correct it but if you get a recurrence, I would suggest you not keep fighting it and remove your implants at that point or live with them as imperfect as they would then be.  And find a surgeon with a great revision policy so your costs are minimized if you have an early (<1 year from surgery) contracture.

Thank you for your question.  Any patient considering implant needs to know, as you do, that there is a chance of re-operation in the future.  Whether it is for capsular contracture, displacement, leak, etc.  The overall risk of capsular contracture is probably in the 2-10% range but it can vary according to the study and several factors.  We do know more about capsular contracture now than ever before.  It may be related to a biofilm associated with bacteria.  Experienced breast surgeons take many precautions to prevent this from happening: no incision around the areola, the use of triple antibiotic irrigation, not touching the implant, and the use of nipple shields.  There are other measures which may help as well such as use of a textured implant and the shaped implants appear to have lower capsular contracture rates compared to round implants.  If your surgeon follows these steps, it will help minimize the chances of capsular contracture but you must be prepared for possible revisional breast surgery no matter what.  Hope this helps.

Tracy Pfeifer, MD, MS

Generally the risk is around 10%, however with the advent of Strattice, this risk can be dropped to almost 0%.  Strattice is usually used if you get a capsular contracture due to the cost, however it is nice to have a solution for the problem if it does occur.  

The risk of capsular contracture has been reported as up to 20 to 30% for a smooth walled muscle above the muscle and as low as .4 - 1% for a smooth walled implant placed below the muscle using the no touch technique.  We will never be able to make the risk for a capsular contracture zero but to decrease the risk proven factors include:      submuscular implant placement, avoiding surface contamination of the implant at the time of insertion, the use of the IMF incision, irrigating with a triple antibiotic solution and post operative massage.    up to  

This question is constantly investigated and the rates are reported as less than 2%, to higher than 10%. Rates are different for silicone gel (higher) than saline, implant location (submuscular much lower), and incision location (lower for inframammary and axillary). The rates are even lower by region (lower in Europe). And strangely, when they occur they are frequently in one breast and not the other. Despite all, augmentation is a very safe procedure with very high satisfation rates. Luck is certainly improved with a well qualified and board certified plastic surgeon.

Capsule contracture, while it does happen, is not a really common occurrence.  Most series report it occurring anywhere from 10 - 20 % of the time, but it is important to remember that this is all forms of capsule contracture, and not just the ones that have to return to the OR for capsulectomy.  There are grades of severity of capsule contracture, and only the more severe forms will have capsulectomy.  The other thing to note is that while it may not look the best or it may cause some discomfort, there is no real health risk or danger involved with isolated capsule contracture, and I think every breast surgeon has more than one lady walking around out there with mild capsule contracture that has nothing done because she still looks good and feels fine.  In my experience capsule contracture that needs surgical revisions occurs 5.8 % of the time in my practice.  When we catch capsule contracture early and it is not too severe, many times we can prevent it by starting on some medication for a couple of months.  In the end, only you can decide if the operation is right for you based upon everything you can learn about it, but in my opinion, the risk of capsule contracture is not so high that it should cause a lady who really wants breast augmentation to avoid the operation.  There were still over 300, 000 of those procedures done in the US alone last year, and most of those women are very satisfied with their results with no capsule contracture.

This is an elusive number to get at unless you specify a few important parameters, such as who is doing the surgery, what type of implants are used, and is the contracture severe enough to warrant surgery. Studies of augmentation performed by Board Certified Plastic Surgeons show a need for more surgery due to significant encapsulation at a rate less than 10%.  In my specific practice the rate is below 2%; colleagues I have queried have similarly low rates.  Ask your doctor for his/her statistics.