I want a breast Augmentation but I am worried about the risks for capsular contraction - is this common?

How common is it?

Doctor Answers 21

Very uncommon, but it can be very technique and surgeon dependent.

There are known risk factors for the development of capsular contracture, and therefore, we have some techniques that we can use to lower that risk.  For most diligent and meticulous plastic surgeons, capsular contracture should happen infrequently.

In some practices, however, capsular contracture is fairly common.  A recent study commissioned by one of the three large implant manufacturers revealed a dramatic difference between surgeons participating in that study.  One plastic surgeon had nearly 4 times the rate of capsular contracture compared to his colleagues.  Since the implant was exactly the same in every office that was part of the study, the difference can only be explained by technique differences between the surgeons.

A no touch technique, the use of dedicated antibiotics during and after the surgery, as well as precise control of bleeding have been the biggest reducer of capsular contracture.  Coupled with higher strength cohesive silicone gel implants and submuscular implant placement have made capsular contracture much less likely than in previous years.

Find a surgeon who embraces these principles, and you'll have little to worry about.

Polyurethane Implants reduce the risk of capsular contracture

Dear Sophie,  Capsular contracture is a risk following breast implant surgery but it usually takes many years to develop.  For this reason, I would be wary of anyone quoting a percentage for capsular contracture without giving a time frame to it - for instance 15-20% at 10 years, which is a commonly quoted rate for silicone implants.

You can see further information about this on my website, but polyurethane foam coated implants can significantly reduce the risk of capsular contracture and so this is something that you may want to discuss with your surgeon.  They are not available in the USA, but they are available in the UK and I think they are good, but I do go through the pros and cons with all of my patients to allow them to make an informed decision.  This is best discussed with your surgeon, but I have given a link to a blog post I have written.  

Good luck. 

Capsular contracture

Capsular contracture is one of the most common reasons patients will have a second breast surgery. It basically is a hard shell of scar tissue that can form around the implant(s), sometimes causing pain and/or distortion/firmness of the implant. The incidence varies depending on the incision site, implant pocket, surface of the implant and surgeon technique. The incidence is in the range of 5-25%. There are ways to minimize it by using an inframammary incision, subpectoral location and textured implant with a funnel insertion. Consult with a plastic surgeon to discuss this in more detail.

William Bruno, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 339 reviews

Is capsular contraction common after breast augmentation?

  Your body will form a scar around any foreign object placed within your body and this includes breast implants.  For the vast majority of breast augmentation patients, the scar capsule remains very thin and soft, like Saran wrap.  When the scar gets thicker (for unknown reasons), the scar tightens or contracts.  This capsular contraction sometimes leads to the breast implant feeling hard and sometimes the breast shape is distorted.  Fortunately, this  is a very uncommon condition, occurring in less than 15% of patients

Rate of Capsular Contracture

Thank you for your important question!

Capsular contracture refers to tightening of the scar tissue that normally forms around the implants resulting in hardened, painful, and abnormal looking breasts with varying degrees of severity. The capsule is fibrous tissue that NATURALLY forms when anything foreign is placed in our body – this happens with heart devices as well. However, when there is too much inflammation, fluid collection, or bacterial contamination, the fibrous capsule can start to scar down further and contract.

In general, capsular contracture (CC) can occur at any time, but most cases are documented in under 12 months (i.e., anywhere from 3 months to 12 months post operation). This is because it takes time for the fibrous tissue capsule to form around the implant, and then it will have to scar down (contract).

Nevertheless, CC can start early when there is significant bleeding or infection or another co-existing problem.

There are 4 grades/levels of capsular contracture:

Grade I — the breast is normally soft and appears natural in size and shape

Grade II — the breast is a little firm, but appears normal.

Grade III — the breast is firm and appears abnormal.

Grade IV — the breast is hard, painful to the touch, and appears abnormal.

Often other studies will only consider Grade 3-4 as capsular contracture as they actually require surgery (i.e., tearing of the capsule, or complete removal of the capsule and the implant). However, some will include 2 as well causing the rate of capsular contracture to be higher. So let’s first understand that this is one reason for the variability in the rates. The risk of capsular contracture can depend on many things like incision site, pocket location, implant and surgical skills. From anecdotal evidence of many surgeons, the rate of occurrence can range from 1-2%.

Older studies (i.e., before year 2000) report capsular contracture to occur in up to 59% of patients, and its recurrence after correction surgery can be from 18.1-39.7%. More recent studies hint that capsular contracture rates range from 1-2% for breast augmentations through the inframammary incision and the transaxillary incision, over it is higher (up to 9%) for surgeries through the periareolar incision.

 

Nevertheless, I don’t think you should be concerned over the rates of capsular contracture from studies, because it clearly varies depending on the surgeon performing the procedure. So it would be better to ask your surgeon about the incidence of capsular contracture when they perform breast augmentations.

 

That being said, a literature review by Dr. Chong & Dr. Deva titled Understanding the Etiology and Prevention of Capsular Contracture (CC), clearly outlines what can increase and decrease the chances of capsular contracture and all things are ultimately related to implant contamination.

 

Initiators:

Bacterial Infection

Periareolar incision (natural bacteria of the breast can contaminate the implant during insertion)

Subglandular pocket (same reason as above)

Prolonged exposure of the implant to the surrounding surgical environment (lack of sterility in the surgical environment can cause contamination of the implant)

Hematoma (blood can increase inflammation and speed up fibrous capsule formation)

Use of drains (increase risk of infections by 5 folds, and thereby increase risk of CC)

Suppressors:

Avoiding large implants (large implants can easily be contaminated)

Avoiding use of drains

Avoiding manipulation of the implant and excessive exposure to open air

Textured implants with subglandular pocket (Textured implants may not help in the submuscular pocket)

Submuscular pocket (the implant is not exposed to breast’s natural bacterial flora)

IV and oral antibiotic prophylaxis during and after surgery

Washing the implant pocket and the implant with antibacterial solution

Using insertion sleeves (i.e., Keller Funnel) for the implants (reduces contact with bacteria)

Using nipple shields to prevent implant contamination from nipple discharge

Achieving blood-less dissection using electrocautery

If these risk factors are considered and incorporated into the surgical planning by your surgeon, the risk of capsular contracture dramatically drops.

I hope this helps.

Martin Jugenburg, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 427 reviews

Capsular Contractions

Thanks for your question. Capsular contraction with modern implants occurs in under 4% of patients. There are a number of factors which  can reduce this, it will be worth asking your surgeon whether they use techniques such as inserting the implant with a Keller funnel and what antibiotics they give you as we believe that both of these reduce the risk of a capsular contracture..

Capsular contracture

Thank you for your question. It is an excellent one. In general capsular contracture rates should be very low if your surgeon adheres to the standard principles intraoperatively and perioperatively that are known to reduce the risk.  This includes the no-touch technique, proper use of perioperative antibiotics, and performing bloodless surgery. I usually quote patients an approximately 4-7 percent chance although this is dependent on the type of surgery, type of implant, as well as timeframe associated with their surgery This is an area of ongoing research and hopefully we can get that rate as close to 0 as possible.

James Shoukas, MD
Lake Mary Plastic Surgeon
4.0 out of 5 stars 5 reviews

Capsule contracture happens, but statistically I would not say the risk is "high," or that it is common

Because we don't really understand all of the reasons why people get capsule contracture, it is difficult to arrive at a standard "occurrence" or percentage that everyone will agree on.  We know from our studies that there are a number of factors which seem to influence capsule contracture, and those surgeons who implement all or most of those things that are surgeon-controlled and which have been shown to decrease capsule contracture, seem to report the lowest incidence.  I can tell you from my own experience this has been the case, as about 10 years ago my capsule contracture rate was a still respectable 5 %, but after making a number of changes in how I do the operation, it is now around 1%.  These rates are quoted for the first year, and I think that is the most important number to know, because the available studies show that 92% of capsule contractures will occur within the first year after the surgery.  While it is definitely possible for capsule contracture to occur later, even many years later, the first year and actually the first few months seem to be most critical in my opinion.  I have seen no definitive studies which show a definite yearly increase in the incidence of capsule contracutre.  Following that logic, we would have to conclude that it is just a matter of time before the majority of all women who have breast implants will get capsule contracture, and that just does not appear to be true.  In fact, as I mentioned above, most ladies, if out of the woods after that first year when 92% of capsule contractures occur, they stay out of the woods, at least with respect to capsule contracture as an isolated problem.  The kinds of things that would influence a later capsule contracture I believe are much different than those which lead to an early occurence.  Especially things like pregnancies and breastfeeding after breast augmentation, are considerations for having some role in these later occurences.  One of the things that makes gathering long term data on things like capsule contracture rates so difficult is that implant tecnnology changes over time, and patients are lost to follow up, so we are often not able to make "apples to apples" comparisons long term.    Taking all of this into consideration, you should also focus on the opposite side of the risk spectrum if you really want to get breast augmentation.  That is, if there is a 1 - 2 % chance that a capsule contracture will occur, then that means that there is a 98% chance that it won't!  That seems like pretty good odds to me, at least good enough that I wouldn't exactly worry about it happening.  You will never find anything a doctor does to or for you with a 0% risk, even taking an aspirin, so this all becomes more of a process of risk assessment and management than one of total risk avoidance.  Best of luck whatever you decide.

Breast Augmentation

Capsular Contracture is perhaps the most difficult complication from breast augmentation.  Meticulous surgical technique with precise pocket dissection, antibiotic irrigation, no touch implant technique with the Keller funnel, submuscular implant placement, and textured implant if the subglandular pocket is used.  These techniques will limit the risk of capsular contracture.

John Burns, MD
Dallas Plastic Surgeon
4.6 out of 5 stars 33 reviews

I want a breast Augmentation

Capsular Contracture is not common.  Your surgeon will go over the risks and benefits of Breast Augmentation.  The rate of satisfaction among my patients is very high. 

All the best to you.


James E. Murphy, MD, FACS
Reno Plastic Surgeon
5.0 out of 5 stars 31 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.