Can the Plastic Surgeon Cause Capsular Contracture by His or Her Surgical Technique?

I was told this by a plastic surgeon "The bottom line is that if your surgeon tells you that CC is something that happens and cannot be predicted or prevented, then he/she clearly is not using these advanced breast implant insertion techniques.' I have capsular contracture IV after 6 weeks from surgery.

Doctor Answers 12

Surgical Technique-Breast Augmentation

I would say that it is not caused by the "surgeon's technique" but rather may be caused by the "surgical technique" meaning one of the common ways to perform the procedure is through the border of the areola and the breast and some postulate that since bacteria live in the ductal system adjacent to the nipple, they can attach to the implant forming a biofilm. This is ongoing research and would first have to proove biofilm causes capsular contracture and then that bacteria from the nipple attach to the implant despite surgical preparation. There are also some good series that show subpectoral placement rather than submammary placement (under the muscle vs. over the muscle) has a lower incidence of capsular contracture. So again, it is not the surgeon but the procedure itself.

Miami Plastic Surgeon
4.5 out of 5 stars 268 reviews

Does the plastic surgeon influence the risk for capsule contracture?

As others said, no one knows for sure. Here's the theory I use and tell my patients:

The first contributing factor is bleeding around the implant right after surgery. This extra blood is an irritant to the wound and sets up a protective biofilm, essentially a hiding place for bacteria. Low grade bacteria, which either get into the breast thru the wound at surgery, the nipple, or through the bloodstream (such as after a sinus infection) then contaminate the biofilm and result in increased growth of bacteria. This then stimulates the natural thin scar tissue capsule that forms around ALL breast impalnts after surgery to thicken and contract.

Therefore, the surgeon does have some influence on this process, but does not have complete control.


Mark D. Epstein, MD
Stony Brook Plastic Surgeon
5.0 out of 5 stars 238 reviews

Breast Augmentation - Can the Plastic Surgeon Cause Capsular Contracture by His or Her Surgical Technique?

Capsular contracture (CC) remains one of the least understood complications of breast implant surgery.  While there are some things are that are believed to be more likely to cause it, it can happen without any of those necessarily happening.  Having it on one side is a good example of how capricious this issue is - is it likely that the surgeon did one thing on one side and something else on the other?  Most surgeons use meticulous surgical technique, antibiotics, etc., and yet CC can still occur.  Tempting as it may be, I don't believe that this particular complication is as directly cause/effect related as the comment you were told.

I hope that this helps, and good luck,

Dr. E

Alan M. Engler, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 125 reviews

Capsular contracture

No one knows for sure why capsualr contractures develop.  Some think it is dues to a low level infection from a subclinical bacterail exposure. Could it happen during surgery?...perhaps.  But remember, the nipple has a connection to the breast gland tissue and bacteria can go through the ductal system as well.  And that is if and only if this theory is true.

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

Early capsular contracture after breast augmentation

The statement that the second plastic surgeon apparently made sounds a bit arrogant, self-serving and possibly even naive. Generally, capsular contracture is fairly unpredictable in a particular patient prior to surgery who has not had breast implant surgery in the past. Yes, it is possible that certain substandard techniques can increase the risk for capsular contracture but this would be more the exception than the rule.

Steven Turkeltaub, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 30 reviews

There are several things that Platic surgeon can do to prevent most cases of capsular contracture.


I think specially when capsular contracture happens soon after surgery, there may be something that could have been done to prevent it (complete control of bleeding,  super sterile no touch technique, antibiotic irrigation, intravenous antibiotics, etc.).

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon
4.8 out of 5 stars 9 reviews

Surgical techniques can cause capsular contracture

Capsular contracture is the leading complication after breast augmentation, and strictly speaking, surgical technique can cause a higher capsular contracture rate. Contamination of the implant, bleeding within the pocket, infection, can all lead to capsular contracture. Cause and effect is hard to pin down as capsular contracture is an elusive problem. To claim one has an 'advanced technique' which will prevent capsular contracture, or predict the cause is a bit fanciful. If you choose a surgeon with a respected practice and board certification and a accredited facility your risks will be controlled.

Best of luck,

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 42 reviews

Capsular Contracture and Surgical Technique

I am sorry that you have developed severe capsular contracture so soon after surgery.  At this early stage, severe capsular contracture is usually related to either postoperative hematoma or low grade infection.  There are a lot of theories about technique issues related to capsular contracture, but in my opinion, there is no strong evidence that these techniques lower the incidence of capsular contracture over using normal sterile techniques.  All surgeons who do breast implant surgery have patients with capsular contracture or they have not done enough surgeries or followed their patients long enough to know it has happened. 

It is probable that you will need additional surgery to try to correct the contracture.

Good Luck

Don W. Griffin, MD
Nashville Plastic Surgeon
4.8 out of 5 stars 72 reviews

Capsular Contracture

Capsular contracture has been a problem since the beginning of breast augmentation, and any surgeon who claims that it can always be prevented (and as such imply that it never happens in his or her practice) either hasn't done too many or isn't paying attention. The leading theory of the cause is a low-grade infection in the form of a biofilm, but post-operative bleeding can also be a factor, and in most cases we never know the cause. Stick with your plastic surgeon and together the two of you should be able to get this problem resolved. In general, avoid any surgeons who claim they never get comlications.

Joseph Fata, MD
Indianapolis Plastic Surgeon
5.0 out of 5 stars 101 reviews

There are multiple causes of contracture immediately after surgery

If you are in stage four contracture six weeks after insertion there may be more than one reason for this but we would never be able to tell you why it happened, only suggest where it might have gotten started.  If this side had a whole lot more bruising than your other side it might have been related to post operative bleeding.  If there was an infection of the incision on this side it might have been related.  if you had a major infection elsewhere after surgery such as a severe bladder infection it might be related to that.  Simply saying your contracture is because the surgeon didn't use the latest techniques ignores a whole lot of other factors that may be in play here.

I really regret that this happened to you and if it doesn't improve soon you will unfortunately need corrective surgery to make it better.  Keep going back to your surgeon for his advice.

Phillip C. Haeck, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 37 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.