Capsular Contracture

All breast implants develop a thin layer of scar tissue around them called an “implant capsule.” In some cases, the scar tissue becomes thicker and tighter, and this results in a firm implant, or capsular contracture. This is believed to be the most common complication of a breast implant. An implant may become rigid, or the breast can be distorted and even painful at times. The cause of capsular contracture can be difficult to determine, but it is most likely the result of a low-grade infection, blood around the implant after surgery, or a patient who simply is a “hard healer” and makes firm scar tissue. It can occur at any time, but generally most cases will be seen within five years after surgery.

Who is likely to develop a breast contracture?

In my experience, it is more common in a patient with subglandular implants (implants placed above the muscle) and less common when active breast massage is performed to keep the breasts soft. Patients who develop a breast infection after surgery will almost always develop a contracture, as will those patients who develop a hematoma around a breast implant that is not treated by removing the blood. Implants older than 20 years often let you know they are worn out by developing a contracture.

What is the best treatment for capsular contracture? 

Treatment of a breast contracture usually involves implant change, pocket change, and capsulectomy. Removal of the implants is also an option. The use of Acellular Dermal Matrix, or ADM, has proven helpful in breast implant contracture, but more studies are needed to establish the effectiveness.

Which implants contract less—silicone or saline? 

There is conflicting evidence regarding this issue. There probably isn’t much of a difference in the contracture rate between these implant types.

Do textured implants reduce the risk of capsular contracture? 

There is conflicting evidence regarding this issue; however, I use mostly smooth-walled implants because they contract less in my hands.

How successful is surgical treatment for capsular contracture? 

There is no guarantee that you will be contracture-free after surgery, but my experience shows that the success rate is very high (well over 80 percent).

Does the contracted capsule have to be removed? 

It all depends on the individual case. If removal of the capsule is possible, it is a good idea to remove as much of it as possible. If the capsule is over 15 years old and calcified and brittle, removal is warranted, as it can be uncomfortable if it remains and may interfere with mammography.

Is it possible to break up the scar tissue by having my surgeon smash on my breasts? 

This is called a closed capsulotomy and is not recommended, as it doesn’t work and may break your implants.

Is there a medical or non-surgical treatment for breast contracture? 

No. Some therapy options including medications, injections, and ultrasound treatments have been offered, but none have proven to be effective. Beware of Internet claims of success with anything other than surgery.

Can I choose to just live with my contracted implants? 

You can certainly live with a contracture, as it will not harm your health. Remember that a contracture is simply a thin layer of normal scar tissue that the body has made around a foreign object (the breast implant).

What are the symptoms of a breast contracture?

The breast becomes firmer and less mobile, distorted in shape, or painful. The breast implant usually moves upward. The breasts can appear “stuck on” and less natural in appearance. The worst outcome is a rock-hard, painful breast.

Do antibiotics reduce the incidence of capsular contracture? 

The evidence here is not entirely clear. Most surgeons will use antibiotics after a breast enhancement even though the evidence does not support its use.

Does a capsular contracture get softer over time?

It’s possible that the firmness of the breast implant may soften to some degree with time, but an established contracture is not likely to change.

Is there anything new that helps with capsular contracture? 

The use of ADM, or Acellular Dermal Matrix, has shown promising results in reducing capsular contracture in those who undergo breast revision surgery. My personal experience with the material has been favorable.