Early Capsular Contracture: Why It Happens and What to Do

Fantastic question, and an important one, because early contractures are a very different animal than later contractures.

The causes are the same list you'd see for a contracture that shows up years later. What changes is which cause is actually likely when the problem appears within weeks or months of surgery.

One of the classic causes of contracture is a ruptured silicone implant, because the internal silicone is irritating to the body.

But that's not a common cause of an early contracture. It's genuinely rare for implants to rupture right after surgery. Rupture is a problem that typically shows up years out, not right away, unless there was some kind of misadventure at the time of surgery, which is rare.

So if you're firming up at six weeks, this is almost certainly not your explanation.

A hematoma, a collection of blood around the implant, is not a common cause of contracture in general. But in my experience, it's a more common cause of early contracture.

You usually know you have one:

• One side gets very large
• You are bruised
• You have more pain on that side

Some small hematomas will go away by themselves if you give them enough time. I'm still a big fan of evacuating them, even the smaller ones, and this is one of the main reasons why. Leaving blood in place:

• Raises your risk of capsular contracture
• Can leave the pocket for your implant too large, which means more implant malposition
• Can cause stretching and distortion of the tissue, so your symmetry isn't as good

If this happens to you, your doctor will talk through the options, because evacuating a hematoma is an additional surgery and an additional expense. I still think it's the better path, because it can prevent a complication that is really expensive to fix later. (Here's more on how hematomas are managed, including the one version that's a true emergency.)

The other big early cause is biofilm, a low-grade, subclinical infection living on the implant surface.

When I interview patients who come to me to correct an early contracture, they usually tell me some version of the same story. Several weeks after surgery they had:

• Redness
• Drainage
• A fluid collection
• And they were treated with antibiotics

That is the classic history of someone who develops a biofilm on their implant and then develops an early contracture. If that sequence sounds like your recovery, it's worth taking seriously.

You'll hear different opinions from different plastic surgeons. Here's mine, plainly:

Here's the part that makes the medication question worth discussing at all: you can't go back in surgically right after surgery.

You need to wait for the scar tissue to soften and for the initial healing to happen over the first couple of months. Waiting makes the operation easier to do, means less bleeding, and is simply a safer procedure.

Since you're waiting regardless, there are medications that may slow things down if you start them very quickly, and there's some evidence behind them:

• Large doses of vitamin E
• Singulair (montelukast) or Accolate (zafirlukast)
• Doxycycline, an antibiotic, which is started specifically to address biofilm

I want to be honest about my own view: I'm not a big believer in medications for stopping a capsular contracture. I really haven't found them very effective. But it's certainly worth a try, because you're not operating during that window anyway.

Some people use a device called Aspen, an ultrasound device, and believe it treats contracture.

I am a firm believer that it does not.

They sent me promotional material with, frankly, some of the most ridiculous before-and-after photos I've seen. They were before-and-after surgery photos presented as though the device produced the change.

The pitch is that if you use it early, things will soften up. Here's the problem: things soften anyway. That's just the natural course of healing and the remodeling of collagen. If you have the money and you want to try it, sure. I wouldn't recommend it. (I've laid out my full position on Aspen and the other non-surgical options elsewhere.)

An early capsular contracture has the same cause list as a late one, but the odds are different:

• Ruptured implant is almost never it this early
• Hematoma is uncommon overall but overrepresented in early contractures, and I'd rather evacuate it than wait it out
• Biofilm is the classic culprit, and the tell is redness, drainage, or a fluid collection treated with antibiotics a few weeks after surgery

You'll most likely need surgery eventually, and you'll need to wait a couple of months regardless so the tissue can soften and the operation can be done safely. In the meantime, the medications are a reasonable thing to try even if I'm skeptical of them, and I'd skip the ultrasound device.

When it is time to operate, how the revision is done matters enormously, and it's the single biggest factor in whether the contracture comes back.