How to Properly Treat Capsular Contracture

Capsular contracture is when the scar tissue sac (capsule) that your body naturally forms around a breast implant becomes thick and abnormal. As it thickens, it compresses the implant. It starts with the implant feeling firmer but looking normal, and can progress all the way to a visibly distorted breast with severe pain.

In Dr. Killeen's experience, capsular contractures happen for two main reasons:

1. Ruptured silicone implant — silicone leaking into the surrounding tissue triggers chronic inflammation
2. Biofilm — certain bacteria colonize the surface of the implant. Biofilms are well-documented around implants in general, but some patients don't respond to them the way we'd hope, leading to chronic inflammation and contracture

Dr. Killeen's approach to managing capsular contracture includes:

• Complete capsule removal — the entire thickened scar tissue capsule should be taken out
• Bacterial testing — since biofilm is a low-grade subclinical infection, Dr. Killeen sends a MicroGen PCR test to look for bacteria (standard cultures around implants are unfortunately not very reliable)
• Fresh implant — a brand new implant is always used, never the old one
• Antibiotics — to manage potential biofilm while waiting for test results
• Recurrence prevention — using materials like dermal matrix or GalaFLEX to help minimize the chance of contracture coming back

Dr. Killeen recently treated a patient who had multiple failed attempts at fixing her capsular contracture. Here's what went wrong:

Instead of removing the thickened capsule, the previous surgeon kept creating new pockets (called neopockets) right over the old ones. The patient ended up with multiple layered capsules — and the contracture kept coming back.

There was a large amount of brown liquid (Betadine) around both implants, which is not standard practice for most surgeons and shouldn't be present long-term.

On one side, the same old implant was used repeatedly instead of being replaced with a fresh one — a clear deviation from best practices.

Rather than addressing the underlying problem by removing the capsule, a textured implant was placed on one side in an attempt to prevent recurrence.

Capsular contracture requires addressing the root cause — removing the capsule, testing for bacteria, using a new implant, treating with antibiotics, and using materials that help prevent recurrence. Shortcuts like creating new pockets over old capsules or reusing implants don't solve the problem and can lead to years of unnecessary discomfort.

If you're dealing with recurring capsular contracture, make sure your surgeon has a comprehensive plan that addresses all of these factors. Learn more about breast revision surgery options.