Ask a doctor

How and when Does Capsular Contracture Happen?

I have breast implants and my right breast keeps getting Capsular Contracture. How and when does this happen?

Doctor Answers 8

Capsular contracture: What is it? Prevention and treatment

That is the million dollar question that no one has the answer to.

There are many theories for why this happens. It can occur almost immediately or happen many months later. It can affect one or both breasts.

People have attibuted this to wound healing, infection, and/or minor bleeding.

Probably the most widely held theory is related to any implant and popular thought attributes this to a biofilm that develops on the surface of any prosthesis. This is actively being studies as it relates to implants used in many fields of medicine such as orthoedics, cardiac surgery, dental surgery, urology, plastic surgery, etc.

A biofilm is a layer of bacteria with their associated excreted proteins that forms a layer over the surface of the implant. The bacteria become dormant and somewhat resistant to normal doses of antibiotics.

This is somwhat similar to the shiny slime that develops on a rock in s stream. Despite the cleansing action of the stream the slime remains on the rock.

The bodies response to the biofilm (sometimes called bioslime) results in some of the complications associated with implants including capsular contracture.

Studies are currently being aimed towards preventing adherence of the bacteria Others are trying to figure out how to dissolve the fim which is very resistant.

Prevention with use of antibiotics and a minimal touch/handing is one of the best methods to minimize development of the biofilm. Once developed, the only tried and true method is to replace the implant or remove it entirely as well as remove an established capsular contracture.

This is the prevailing theory. This is a very cursory review of a very complex subject and is clearly not all inclusive nor definitive.

I hope this helps.

Chicago Plastic Surgeon
5.0 out of 5 stars 60 reviews

Uncertain when capsular contracture happens


Thank you for your question!



I hope this helps.

Sam Speron, MD
Chicago Plastic Surgeon

How and when does capsular contracture happen?

Hello! Thank you for your question! Physical examination will determine if you have capsular contracture. The look and feel of hardness surrounding your implant is seen and/or felt. At its worst, you experience pain. It may also cause distortion of your breast. What has caused it is still in question. Most will develop within a year postop. 

Your surgeon will likely recommend implant massage and may add the medication Singulair. If these fail, surgical correction may be suggested. It is a matter of surgeon preference as well as what is seen during your procedure that will determine whether or not a complete capsulectomy is performed. If significant capsule formation is seen intraoperatively, a full capule removal may be warranted with a drain in order to completely remove all of the tissue and allow better adherence of your breast back to its normal anatomic position down on your chest wall. Irrigating with certain medications may also be if benefit. If minimal contracture is seen, it may be possible to leave the capsule, or place cuts within the capsule to allow better adherence. It truly is dependent on what is seen with your capsule and the issues that may be causing you to have such a procedure (e.g., contracture from rutptured implant vs pain vs simple pocket adjustment, etc).

Without knowing your issues and without an examination, it is difficult to tell you what may be the best thing for you. I tend to favor performing capsulectomies in order to create a fresh pocket, reshape the pocket, allow better shape and adherence of the overlying breast. I would discuss your issues with your plastic surgeon who will assist you in determining the right modality for you. Hope that this helps! Best wishes!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 14 reviews

Breast Implants and Avoiding Capsular Contracture






Michael Law, MD
Raleigh-Durham Plastic Surgeon
5.0 out of 5 stars 70 reviews

Sooner or later but it's not understood

Why capsular contracture happens we don't really know. But we do know that there are things that can potentially cause it and things that decrease its incidence. Previously various medications such as antibiotics and other sterilizing agents were used to irrigate the pocket prior to implant placement. These have been found to cause irritation and capsular contracture.

When the capsular contracture happens is another questions but typically it is a delayed phenomenon, perhaps years. But the reality is that it is seldom seen nowadays since we have been putting implants under the pectoralis muscle. So don't worry about it.

Some risk factors can be prevented, others cnnot

Some folks will develop contracture despite our best efforts, and as long as your surgeon is replacing your implants with new implants, removing the entire capsule, putting on an antibiotic regimen and a massage plan after the procedure, and being meticulous with control of bleeding, everything that can be done is being done. There may come a point then that you will have to decide how bad the contracture bothers you and if you want the implant removed permanently.

Shahram Salemy, MD, FACS
Seattle Plastic Surgeon
5.0 out of 5 stars 124 reviews

Implants and you may not mix

Please read Dr. Placik's excellent review of capsular contracture etiology and treatment. When your body shows that capacity to make a capsular contracture, it can continue to do this on a repeated basis despite all measures to the contrary.

Basically you need to make sure that your surgeon has removed all of the capsule and replaced a new implant in the pocket. If your implants were above the muscle, they should be moved below the muscle. Taking Vit E after surgery and a vigorous massage program can sometimes halt the development of future contractures. In the end, if nothing works, you will need to decide if it is bad enough to be willing to have the implants removed and left out.

Capsular contracture

That is a great question. No one knows for sure why it develops. There are a lot of different theories. One of the more popular ones relates to the notion of a subclinical infection leading to a gradual capsular contracture.

Steven Wallach, MD
New York Plastic Surgeon
4.0 out of 5 stars 22 reviews
