Capsular Contracture – Causes and Prevention


Breast augmentation is a popular surgical procedure that aims to enhance the size and shape of the breasts. It’s important for those considering breast implant surgery to have a good grasp of potential complications. This guide focuses on two issues: capsular contracture and implant issues.

Capsular contracture happens when scar tissue tightens around the implant, causing discomfort and breast distortion. It’s crucial to understand the causes, symptoms, prevention, and treatment options for this condition. Plus, implant issues like rupture, leakage, or displacement can occur over time. In many cases, the best course of action to remedy these issues is to have breast implant removal surgery.

By understanding these potential complications, individuals can make informed decisions about their breast health. Remember, seeking advice from a specialist plastic surgeon is key for personalised guidance in addressing these concerns.

What is Capsular Contracture?

Capsular contracture is when scar tissue forms around breast implants, which can be a common issue after breast augmentation. This scar tissue tightens and creates a firm capsule around the implant, resulting in noticeable breast hardness, shape distortion, and discomfort. It can affect the appearance, comfort, and lifespan of the implants. Detecting and treating it early is important to address the problem and prevent further complications.

Capsular Contraction: Causes and Treatment


There are a few things that can contribute to capsular contracture, including:

  1. Bacterial Contamination: Sometimes, bacteria can get into the body during surgery or from an infection elsewhere. This can cause an inflammatory response, leading to excess scar tissue and capsular contracture.
  2. Genetic Predisposition: Some people may have genes that make them more likely to develop capsular contracture. We don’t fully understand which genes are involved, but genetics can influence how the body reacts to foreign objects like breast implants.
  3. Postoperative Recovery Instructions: Following the surgeon’s recovery instructions is really important. Neglecting proper post-surgical care can increase the risk of complications and affect how the implant settles and the capsule forms.

Remember, it’s crucial to take these factors into account to minimise the risk of capsular contracture.

Grading & Treatments

Capsular contraction severity is classified into four grades, reflecting the extent of the complication.

  • Grades 1 and 2: Treatment involves monitoring and conservative management techniques like massage, medication, or other non-invasive methods to alleviate symptoms and prevent progression.
  • Grade 3: Non-surgical treatments aim to provide relief and may include more aggressive massage, anti-inflammatory medications, or ultrasound therapy.
  • Grade 4: For significant breast distortion and discomfort, revisional surgery is necessary. This typically involves removing the hardened breast implant capsule and replacing the implant. The surgeon may also consider changing the implant position or type to reduce the risk of future contracture.

Capsular Contracture Causes

Bacterial biofilm is when bacteria sticks to the implant, causing inflammation and making the breast implant hard (capsulated implant). To reduce this risk, it’s important to prevent bacteria from forming around the implant.

Implant Placement: where you put the breast implant makes a big difference in the risk of capsular contracture.

  • Putting it above the muscle (subglandular placement) may increase the risk.
  • Putting it below the muscle (submuscular placement) might lower the risk.

Infection and Hematoma: Infections during or after breast augmentation surgery can potentially lead to capsular contracture. Infection can cause excessive scar tissue formation around the implant. Hematomas happen when blood accumulates in the area, causing inflammation and contributing to capsular contracture.

Genetics and Immune Response: Genes can have an impact on how your immune system responds and the chances of developing capsular contracture.

Capsular Contracture Prevention and Risk Reduction

Proper implant placement techniques are crucial for minimising complications in breast augmentation. Surgeons need to take into account things like tissue coverage, patient anatomy, and implant size. Placing the implant below the muscle (submuscular placement) is often preferred to lower the chances of capsular contracture and implant malposition.

Follow-up Care

Patient Education: Understanding factors that contribute to the issue, like avoiding heavy lifting and sleeping positions that put pressure on the surgical site.

Massage Therapy: Massage therapy might help prevent capsular contracture by improving blood flow and reducing swelling.

Post-Surgical Caution: Don’t hug tightly or engage in strenuous activities during the healing process to prevent bleeding and excessive pressure on the surgical site.

Capsular Contracture Treatment Options

  • Capsulectomy is a surgical procedure to remove thick and hardened tissue around breast implants, aiming to soften their look and feel. It can be done alone or with implant replacement.
  • Another option is en bloc breast implant removal, which removes implants and scar capsules as a single unit to minimise complications.
  • Non-surgical ultrasound therapy is also emerging as a potential treatment.

Breast Implant Complications

Breast implant malposition refers to the improper placement of implants within the breast pocket, including rotations or shifts from their intended position.

This can lead to issues such as breast asymmetry, discomfort, and aesthetic concerns. There are different types of malposition, including subglandular (above the chest muscle), submuscular (below the chest muscle), and double-bubble (implant slipping below the natural breast crease).

Breast implant malposition can occur due to surgical technique errors, factors like capsular contracture and improper healing, as well as genetic factors, implant size, and individual anatomy. Symptoms include breast asymmetry and the visibility of implant edges or ripples, which can result in a misshapen appearance. Corrective procedures involve modifying implant placement and adjusting the implant pocket to restore natural and aesthetically pleasing breast symmetry.


How can I lower the risk of capsular contracture?

  1. Choose the right implant size and type.
  2. Limit points of contact with the implant to reduce bacteria.
  3. Use submuscular placement to avoid implant issues.

How long does it take to recover after breast implant surgery?

Usually, it takes a few weeks to get back to regular activities, but complete healing can take a few months. Keep in mind that the timeline may vary based on individual factors and the surgical technique.

Can I breastfeed with breast implants?

It is possible, but it’s important to consider factors like the surgical technique and implant type. It’s a good idea to consult with your surgeon and a healthcare professional if you’re planning on breastfeeding with implants.

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