Causes of Capsular Contracture

Scars around the breast implants occur in everyone who has had a breast implant. This is normal. In my explanation it is similar to the lining of your coat pocket. This lining can stretch or shrink and we do not know how to control it.

It can happen in one breast or both. It can happen soon after surgery or years later. We cannot predict who will get capsular contracture (shrinkage of the scar tissue) or capsular relaxation (stretching out of the scar tissue).

If the scar capsule shrinks it will squash and compress the breast implant. This makes the breast implant feel hard and become rounded. If part of the capsule shrinks it can push the breast implant out of position – usually upwards. The firmness can vary between a little firm to very hard. The breast implant does not move around. It stays in one position, even if you lie down. It happens in about 15 – 20% of patients if the breast implant is on top of the muscle and 3 – 5% if the breast implant is partially under the muscle.

There are no known statistics for capsular relaxation. In this situation there is too much room around the breast implant and the breast implant moves around too much. When you lie down the breast implant moves too far outwards to your side leaving the breast area empty. When you stand up the breast implant moves back to the right place and looks good. It feels very soft. In my personal observation it seems to be more likely in people who are over weight or who have lost a lot of weight.

Many people suspect that the cause of capsular contracture might be due to a sub clinical infection. In other words, the infection is so mild that you do not know anything about it. Perhaps a few bacteria are going through the bloodstream, and before your natural defenses can kill them off they land on a breast implant. Because a breast implant is not living tissue it has no defenses of its own and the bacteria can live for a while and stimulate the scar capsule to shrink. Another theory is that blood around the implant can irritate the tissues and cause contracture. I always try to do the procedure with as little bleeding as possible.

I recommend antibiotics be given in a single large dose before any dental treatment – including teeth cleaning. This is because some bacteria are often released into the blood stream during dental care, and we guess that they may have a chance to land on the breast implant. Antibiotics could perhaps kill those bacteria before tey find the breast implant. This is only an unproved theory, but it seems like a good idea.