What To Know About Capsular Contracture And Breast Implants

Thinking about getting that breast augmentation? Maybe you’ve always thought about breast implants. Or maybe you finished breastfeeding and your family is complete. Perhaps you’ve been doing your research and came upon something called capsular contracture. While breast augmentation with implants is consistently among the most popular cosmetic surgeries – and the procedure is generally considered safe and effective – no surgery is without risk. In the case of breast implants, capsular contracture is a complication that prospective patients should be aware of. For this article, we tapped top plastic surgeons to learn more about what capsular contracture is, what causes it, how it should be treated, and what you can do to prevent it.

What Is Capsular Contracture?

When a foreign object like a breast implant (or any kind of medical implant) is placed in the body, a ‘capsule’ of scar tissue forms. This is a natural part of the healing process. “When our body encounters a foreign object, it naturally forms a scar around it,” says Elise Min, MD, a board certified plastic and reconstructive surgeon at Cassileth Plastic Surgery in Beverly Hills. It’s what happens to that scar tissue over time that takes it from normal or complicated. “In some patients, this scar can thicken over time and can distort the breast shape and even cause discomfort,” Dr. Min shares.

As such, “a capsular contracture is when the capsule or scar tissue around a breast implant becomes unusually hard and contracts around the implant,” explains Jules Walters III, MD, a board certified plastic and reconstructive surgeon and founder of The Modern Plastic Surgery and Medspa in Metairie, LA. This tightening can have several effects. “A tight capsule can cause the implant to feel firmer, ride higher, or become painful,” says Anna Steve, MD, a plastic surgeon at Neinstein Plastic Surgery in New York City.

So, just how common is it? “Capsular contracture rates range among different publications, but the average is around 10 percent,” says Melissa Doft, MD, a double board certified plastic and reconstructive surgeon in NYC. “It should be noted that 75 percent of capsular contractures occur in the first two years after surgery, but they can occur much later.”

There are ‘grades’ of the condition, which means it doesn’t present the same for everyone. Symptoms include firmness, distortion to the shape of the breast, and, sometimes, pain. “The first symptom is a hardening of the implant,” Dr. Doft shares. “The implant does not feel as soft as it once did.” That can lead to aesthetic impacts. “In more significant capsular contracture, the breast may appear distorted – lifted or the nipple is no longer in the center,” she explains.

Why Does Capsular Contracture Happen?

There are several theories as to why capsular contracture occurs — and it most likely varies from patient to patient and is multifactorial. “Some causes include ruptured implants, hematoma, and a ‘biofilm’ layer, which is a thin layer of bacteria that leads to a chronic, low-grade infection,” Dr. Min says. Those who tend to develop thick scars may also have a genetic predisposition. “All of these factors can lead to more aggressive fibrous scar tissue around the implant leading to capsular contracture,” she notes.

Capsular contracture is more common in women who receive breast implants after breast cancer and need radiation therapy, Dr. Steve notes. And then there is technique. “Placing implants in front of the muscle or through incisions in the armpit or around the nipple also increases the risk of capsular contracture,” she shares. Data indicates that placing implants under the chest muscles can lower the chance of capsular contracture from about 12 to 18 percent lifetime risk for over-the-muscle cases to 4 to 8 percent.

How Should You Treat Capsular Contracture?

Here’s the interesting thing about capsular contracture, it’s not a ‘dangerous’ complication. “It does not necessarily pose a health risk to the patient,” Dr. Walters says. “But capsular contractures can become painful and can cause asymmetry to the breasts.” Needless to say, this can have a big impact on the patient. As he explains, it often leaves them “feeling insecure about the appearance of their breasts.”

The reason why capsular contracture is treated is not because it’s life-threatening, but rather because of its quality of life implications. “It's important to know that it's usually not dangerous to one's health,” Dr. Min shares. “However, in the context of breast implants, it often alters the appearance of the breasts — which is why it is frequently treated.” Just as there are different grades of capsular contracture, there are different ways to treat it.

If you think you have capsular contracture, Dr. Steve recommends returning to your plastic surgeon. “In most cases, a small surgery to release the tight capsule will be performed,” she says. In other cases, replacing the implants may be necessary. “If your implants are in front of the muscle, having your implants placed under the muscle can help decrease the risk of the capsule becoming tight again,” Dr. Steve shares. In such situations, the existing implants and thick capsules are removed and replaced with new implants. Our experts share that adding a dermal matrix can also help lower the risk of recurrence.

It should also be noted that manufacturers may cover some or all of the cost of revision. “The implant companies have created warranties to help pay for corrective surgery after capsular contracture,” Dr. Doft says. For example, the Sientra warranty stipulates that patients are entitled to “free implant replacement for complications of capsular contracture (Baker Grade III/IV), late forming seroma, double capsule, and BIA-ALCL” for 20 years and “up to $2,000 for uncovered fees and costs due to capsular contracture (Baker Grade III/IV), late forming seroma, and double capsule” for two years.

Can You Prevent Capsular Contracture?

The short answer is yes, Dr. Doft says. Limiting the handling of the breast implants during surgery decreases the risk of capsular contracture. “Most board certified plastic surgeons follow the 14 Point Plan, which is designed to minimize the number of bacteria that can contaminate breast implants at the time of surgery,” Dr. Walters explains. Choosing the right implant size, type, and placement for your aesthetic goals and needs is also important. “Having your implants placed under the muscle – through an incision under the breast – and choosing the right size of implant for you decreases the risk,” Dr. Steve adds.

Additionally, don’t underestimate the importance of pre- and post-op planning. Dr. Min says that it's important to have a preoperative discussion with your surgeon about reducing the risks of possible bleeding. This includes certain medication use, foods, genetic propensity, and smoking. Post-surgery, Dr. Min notes that there is some evidence to suggest leukotriene inhibitors could reduce the risk of developing capsular contracture. Finally, “some plastic surgeons believe that massaging the implants when they are first placed can help prevent capsular contracture,” Dr. Doft shares.

As with any surgery or procedure, following your surgeon's recommendations pre- and post-op can go a long way towards a favorable outcome.