How much higher is the risk of capsular contracture with subglandular than submuscular?

The rate of capsular contracture in sub glandular implants is generally higher than in sub muscular implants due to the highly vascularized muscle protecting the implant from the back side of the breast. Closely comparable rates of capsule contracture in the sub muscular placement can be achieved with a sub fascial placement of the implant, which adds a layer of fascia between the backside of the breast and the implant and can be an excellent option for patients who don’t want a sub muscular placement. Have a detailed discussion with your plastic surgeon about the best options for you. Best wishes.

The risk overall of developing capsular contracture is relatively low. It is slightly lower with under the muscle versus over. There are other factors that can influence capsular contracture as well, such as an implant that is too large for the breast space. I've included a video discussing capsular contracture that I hope you find helpful.

The risk is over double. The reason is that in subglandular plane the implant is in direct contact with the breast tissue which contains milk ducts and bacteriae live in milk ducts. So there is more risk of chronic contamination and development of a reactive capsule.

Exactly how much is difficult to be agreed upon, some say twice as much. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

But beyond excess risk of cc, placement of implants over the muscle puts you at risk of implant visibility, rippling, and tissue atrophy in the upper and medial poles of the breasts, especially over time. The new rage of 'subfascial' implant position is no different, and will soon come tumbling down as we see these patients 5, 10, or 15 years later. Subpectoral placement will give the most durable results.

The risk of capsular contracture with smooth round implants is higher in the subglandular plane. The newly approved Motive implants have a unique surface that resists capsular contracture and would be a better choice in the subglandular plane.

You will have a hard time finding an accurate answer to this question. It has been difficult to accurately study so you can expect different answers from different surgeons

Dear LexieCooper,
capsular contracture happens. In fact, every implant has a capsule form around it, its just a certain percentage develop thick capsules. There is a lot we don't know about it actually. Some think that bacteria that gets on the implant during insertion can increase the risk. Thats why we use a Keller Funnel in our practice to reduce that possibility. Our capsular contracture rate is less than 2% because we use a keller funnel as well as meticulous operating room techniques.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Many papers dealing with this issue would state that there is slightly larger frequency of breast implant related contracture when implants are placed in subglandular position, above the muscle. However, most plastic surgeons would select that location in well selected patients dispute this fact in order to achieve benefits of better shape control, for example. Hope this helps.

The risk of capsular contracture is notably higher with subglandular (over the muscle) implants compared to submuscular (under the muscle) placement.
Why the Risk is Higher with Subglandular
• Less tissue coverage, more direct contact between the implant and breast tissue.
• Higher chance of bacterial contamination.
• More exposure to the body’s immune response.
• Less implant mobility, which can contribute to the development of a tight capsule.
Summary
• Subglandular implants may have 2 to 3 times higher risk of capsular contracture compared to submuscular placement.
• Submuscular placement is generally preferred for reducing this risk, especially in primary augmentations.