What We Know and Don’t Know About Capsular Contracture

Capsular contracture is a hardening of the scar tissue surrounding a breast implant.  Per reported data from the three major breast implant manufacturers in the United States, along with peer reviewed studies from plastic surgeons looking at breast augmentation surgery outcomes, the rate of clinically relevant capsular contracture after breast augmentation surgery is around 10%.  That means if you have had or are planning to have breast augmentation surgery, your risk of developing palpable scar tissue, aka capsular contracture, is around 10%.


Why does this matter? Primarily because having aggressive scar tissue around your breast implant(s) can change the shape and feel of your breast and can lead to asymmetry and/or hardening on the affected side(s), and in some cases can also lead to chronic discomfort.  This blog will break down our current understanding of how capsular contracture develops, what can be done to treat this problem, and additional research need to fully understand capsular contracture.

In my practice, the rate of capsular contracture after breast augmentation surgery is much lower than 10%.  I realize that this is an anecdotal finding but it does beg the question: why is my rate lower than the national average?  Are my patient’s healthier than those nationally? Is it because my surgical technique is much better than what is found in other areas or that we have a better and more diligent surgical team? Or could it be that we use only higher end silicone implants?  Maybe the fact that we operate in top notch facilities that have extremely low infection rates has something to do with our lower rate? Even though I believe all the above points are true and contributory, the complete answer still eludes us.

So let us start with what we do know:

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1. It is natural and expected for your body to form scar tissue around any foreign object, including breast implants.  In most cases, this scar tissue is thin, flexible and not easy to feel or see. Rarely does it cause a significant problem. 

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2. Scar tissue, aka breast capsules, form around breast implants when cells in your body (fibroblast) creates a collagen net that envelopes the breast implant circumstantially.

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3. It seems likely that contamination of the breast implant at the time of surgery with sterile particulates or local/environmental bacteria does contribute to the development of scar tissue around the breast implant. In some cases, this process of creating a capsule can become extreme and develop into a clinically relevant capsular contracture. 

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4. Texturing of the breast implant and placing the breast implant underneath the pectoralis major muscle has been shown to decrease the rate of clinically relevant capsular contracture. 

Now let us look at what we don’t know:

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1. With improved technique and equipment why as the rate of capsular contracture remained consistent? Capsular contracture rates have not improved nationally, even while we are utilizing better techniques. This includes using a Keller funnel for placement of the implant, soaking the implant in a triple antibiotic solution before placement and ensuring that there is adequate hemostasis at the time of surgery. All these techniques have been assumed to decrease contamination at the time of surgery but for some reason the rates have not changed. Why?

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2. We are also not sure why certain people continue to create a thicker and more aggressive capsule after the body initially walls off the implant from the rest of the body. 

Lastly, let us talk about the treatment:

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1. For mild to moderate capsular contracture that is diagnosed early, a 3-6 month trial of a prescription medication, Accolate, supervised by your surgeon or primary care physician, has been shown to slow or even reverse capsule formation in the short term.

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2. The definitive treatment for capsular contracture is surgical. This will include an exchange of the breast implant with complete removal of the scar tissue.

Capsular contracture is a frustrating problem for the patients affected and the surgeons wishing to prevent it entirely.  I do feel confident that in the coming years, more data will come out that points us into a clear direction for prevention.  In the meantime, if you are considering breast augmentation surgery or you feel that you are developing a capsular contracture following breast augmentation, please seek out a board certified plastic surgeon that has expertise with breast surgery. To learn more, watch or listen to our podcast on Breast Implant Controversies where we discuss this topic in detail.