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Capsular Contracture of Breast Implants : Definition, Mechanism, and Risk Factors

What is a capsular contracture?

Capsular contracture refers to formation of a tight scar surrounding a breast implant following breast augmentation, causing the implant to look or feel hard.  The implant itself does not actually become hard; it just feels like it because it is being squeezed by the scar tissue.

Mechanism of capsular contracture formation

When a breast implant is placed, your body recognizes it as foreign and builds a wall of scar tissue (capsule) around the implant to seal it off from the rest of your body.  This is normal, and it’s a good thing.  On a long-term basis, this capsule provides support to your implants, so they don’t drop down to your belly button later in life.

The problem is that sometimes the scar tissue contracts or tightens around the implants.  This may be due to a postoperative infection or bleeding problem, either of which can increase internal scarring.  Most of the time there is no obvious cause—it just happens.

Risk factors for capsular contracture

1.       Capsular contractures are more common in implants placed above the pectoralis muscle (subglandular implants) than those placed below the muscle (submuscular implants).   It is theorized that the constant motion of the pectoralis muscle over the subpectoral  implants keeps the capsule from tightening excessively.

2.       Capsular contractures are more common with silicone gel breast implants than with saline breast implants.  This is likely related to the foreign—and therefore more reactive–nature of silicone gel compared to salt water.

3.       Among women with subglandular implants (above muscle), capsular contractures are more common with smooth breast implants (smooth implant surface) than with textured breast implants.   Surface texturing (smooth vs. textured) does not appear to make a significant difference if implants are placed in subpectoral position.

4.       Significant trauma to the breast can cause a small amount of bleeding around the implant, precipitating the formation of a capsular contracture.

5.       Immediate postoperative infection, bleeding, or implant exposure significantly increases the risk of capsular contracture formation.

6.       Silicone gel breast implant rupture can cause an inflammatory reaction with silicone granuloma (small nodules adjacent to the implant) formation and/or capsular contracture.

7.       Saline breast implant deflation will not cause an inflammatory reaction.  However, if the implant is not replaced quickly (within a few weeks), the capsule contracts in an attempt to eliminate the empty space left behind by the deflated implant.

We’ll discuss grading and treatment of capsular contractures in the next blog.  Stay tuned…

For more information about breast augmentation, please visit

Ronald M. Friedman, M.D.

Director, West Plano Plastic Surgery Center

Former Chief of Plastic Surgery, Parkland Memorial Hospital, Dallas

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