Capsular Contracture: Causes, Prevention, and Treatment

Anytime you implant a foreign body — whether it's a breast implant, a pacemaker, or anything else — your body recognizes it as foreign and walls it off with a scar tissue sac called the capsule. This is a normal response. Capsular contracture happens when that capsule becomes abnormally thick, compressing the implant and causing firmness, visible distortion, or pain.

Most contractures happen for two main reasons:

When a silicone implant ruptures, the internal silicone gel is irritating to the capsule and causes chronic inflammation, which leads to thickening.

Certain bacteria can form a biofilm on the implant surface. In some patients, this triggers inflammation that leads to a thickened capsule. Biofilm doesn't always cause contracture, but certain people seem to have more trouble with it than others.

Women who have a bleeding complication (hematoma) around their implant — especially when that collection is left to resolve on its own rather than being drained in the operating room — also have a higher risk of contracture. The body's inflammatory response to the blood collection appears to contribute to capsule thickening.

Over the years, plastic surgeons have gotten significantly better at preventing capsular contracture:

• Sterile funnels (Keller funnels) are used to place implants without touching them
• Special irrigant solutions reduce bacterial contamination
• Better incision choices — avoiding incisions with higher contracture rates
• Properly sized incisions so implants aren't damaged going in

The results speak for themselves: older implant approval studies showed contracture rates of 10–15%. More recent studies show rates of less than 2%.

While there's some debate about the specifics, the general approach includes:

1. Remove the entire scar tissue capsule (capsulectomy)
2. Check and treat for biofilm — because if bacteria are driving the problem, it needs to be addressed
3. Reconstruct with recurrence prevention — using some type of support product to minimize the chance of contracture returning

Treatment continues to evolve:

• Dermal matrix was used first — both human and porcine versions. Multiple clinical trials on PubMed document results with these materials for capsular contracture and various breast surgeries.
• Mesh products have become more popular in recent years. One major driver for this shift is cost — for cosmetic patients, the support portion of the surgery is typically not covered by insurance, and mesh is significantly less expensive than dermal matrix.

Capsular contracture rates have dropped dramatically thanks to better surgical techniques and prevention strategies. When it does occur, treatment has also improved — with capsule removal, biofilm management, and evolving support materials giving patients much better outcomes than in years past.

Research continues into which meshes and capsulectomy techniques are superior, with the goal of finding the best possible treatment for every patient. If you're experiencing firmness or pain with your breast implants, learn more about breast revision options.