Capsular Contracture Surgery

All breast implants will develop a thin layer of natural scar like tissue around them, referred to as a capsule. This happens in every breast augmentation, and can be thought of as the body’s mechanism of “walling off” the implant and keeping it separate. This capsule is normally very thin, soft and pliable, and cannot be felt or detected in any way.

Capsular contracture refers to the abnormal change in the capsule when it thickens and tightens (contracts) which can change the feel of the breast (it goes harder) and then can become uncomfortable or even painful.

There are a variety of theories regarding the development of capsular contracture and there are a number of risk factors that have been identified. The most likely cause appears to be a “sub-clinical” contamination of the breast implant with a bacteria from the skin. This is why so many strict precautions are taken during your surgery to minimise any contamination. For example, Mr Pacifico washes the breast pocket and the implant with an antiseptic an antibiotic solution, covers your nipples with dressings, puts on fresh gloves and ensures you are given powerful and long lasting antibiotics. In addition, the sterile implant packet is only opened at the time the implant is needed, so it is exposed to the operating theatre environment for as short a time as possible.

The bacterial contamination theory is also supported by other anecdotal experiences from Plastic Surgeons. For example, there seems to be an association with breast implant capsule development after dental abscess or root canal treatment. Therefore Mr Pacifico advises you to take a short course of antibiotics if you are having significant dental work performed.

Furthermore, the rates of capsular contracture appear to be higher when breast implants are inserted through incisions (scars) in the armpit or around the nipple, compared with Mr Pacifico’s preferred breast crease approach.

The other factors that have been implicated in capsular contracture include the shell of the breast implant. If the implant is placed in a subglandular pocket (on top of the muscle), textured implants have been shown to have a lower rate of capsular contracture. Interestingly though, there is no difference when the implants are placed under the muscle (dual plane).

So, what is the chance of you developing capsular contracture with modern implants and all the precautions taken? The very robust data collected by Mentor (the implant manufacturer most commonly used by Mr Pacifico) for the FDA shows a rate of 3.8% at 10-years for significant capsular contracture. This, combined with other factors, such as implant rupture, lead to a reoperation rate for breast implants of 23% at 10-years. So 1 in 5 women are likely to have revision breast surgery at 10-years after their first breast augmentation.