Capsular Contracture after Breast Augmentation – What is it? Why it occurs?

Capsular Contracture after Breast Augmentation – What is it? Why it occurs?
May 24th, 2013 by Tal Roudner

Capsular Contracture is one of the more common complications seen after Breast Augmentation surgery. Capsular contracture is a condition that can causes the breasts to change their shape, become hard and even painful. While this condition can occur at any time after surgery, it is more likely to occur at the earlier period after Breast Augmentation surgery.

Depending on the severity of the capsular contracture, your breasts may rise up higher on your chest, look constricted and distorted. As the severity of the capsular contracture increases, it may cause the implant’s outline to become visible. Capsular contracture can also make a breast shift away from its usual area entirely.

The body’s normal response to foreign objects of any kind is to create a clear tissue that is similar to scar tissue around it. This tissue is referred to as a capsule, scar capsule or a tissue capsule. When that scar tissue tightens it becomes a capsular contracture.

Breast Augmentation Surgery

When Breast Augmentation surgery is performed, the surgeon creates a pocket for the breast implant. Throughout the healing process, a capsule forms. This capsule is made up of fibrous tissue. It is natural for the body to shrink scar tissue to some degree. Under normal circumstances, the pocket will remain open and allow the breast implant to feel and look natural. When capsular contracture occurs, it is important to note that the implant itself has not hardened. The shrinking capsule compresses the implant, which cause it to feel firm.

Why capsular contracture occurs

The exact reasons for capsular contracture to occur are still unclear. However, it is thought that the following put you at a greater risk to develop capsular contracture following a Breast Augmentation procedure:


When you smoke, the oxygen level in your blood is decreased. This decrease in oxygen could delay your healing process and cause an inflammatory reaction to occur.

Transient Germ Contamination from Your Skin During Surgery

Long-term bacterial contamination or germ contamination of the implant’s shell has the ability to lead to the shrinking of the capsule. When that bacterial contamination is at a subacute level it is commonly referred to as a “biofilm”. This biofilm shrinkage of the capsule occurs due to the body’s natural chronic inflammatory response to the germs/bacteria. Biofilm, today is considered the most probable cause of the formation of a capsular contracture.


You are more likely to experience capsular contracture following an infection due to an extensive inflammatory reaction.

Subglandular Placement

A breast implant placed above the muscle, as opposed to behind the muscle, increases your chance for experiencing a capsular contracture due to higher exposure to bacteria and decreased blood flow around the implant.


A hematoma (bleeding in the pocket created for the implant) is another complication that could cause an inflammatory reaction to occur. Again, this leads to the problem of capsular contracture.

Seroma/Lymphatic Leak

If you have already had seroma (Lymphatic Leak) following a surgery, you could be at a greater risk for experiencing capsular contracture.

Preventing the Formation of a Capsular Contracture

Miami Plastic Surgeon: Tal T Roudner, MDDr. Tal Roudner uses a few methods to reduce the possibility of a capsular contraction formation after breast augmentation surgery:

– A non-touch technique where the gloves are changed and the implants do not touch the gloves or the skin prior to implantation.

– Triple antibiotic solution to bathe the implant prior and after to its placement in the created pocket.

– Re-applying antiseptic solution to the area of the incision prior to insertion of the implant.

– Use of the Keller-funnel to facilitate the insertion of the implant into its pocket without hand or skin contact, reducing the chances of bacterial contamination of the implant and formation of a biofilm.

-Recommendation of the use of prophylactic antibiotics after breast augmentation for procedures that may introduce bacteria into the bloodstream such as during a visit to the dentist for teeth cleaning.

Treating capsular contracture

There are a couple surgical methods used to treat capsular contracture. Dr. Tal Roudner will help you determine which procedure is best for you.

Breast Massage

When the capsule is detected early, frequent massage to round smooth silicone gel implants may improve the hardening of the capsule.


Some anecdotal studies have shown that the off label use of asthma medication such as Singular, has helped early grade I&II of capsular contracture, as well as prophylactic use after surgical correction of previous capsular contracture.

Pocket Site Exchange

If the implant was placed in the sub-glandular position, a brand new implant will be placed in a sub-muscular position. If the implant was placed in a sub-muscular position a brand new implant will be placed in a neo-sub-muscular position.

Open Capsulotomy

This surgical procedure is performed when Dr. Roudner releases the contracted scar tissue that has formed around the breast implant and place a brand new implant. This is done to release the hold it has on the breast implant and create a large louse pocket again. You may be given IV sedation with local anesthetic or general anesthesia for this procedure.

Open Capsulectomy

This is another surgical procedure and it is the most successful treatment method for correcting capsular contracture. During this procedure, Dr. Roudner will go in and remove the scar capsule. This surgery does take longer than the Open Capsulotomy will. Once the scar capsule is removed, your body will create a new capsule around the brand new breast implant.



Currently still been evaluated is the use of acellular dermal matrices (ADM), after partial removal of the capsule and replacement of the capsule with the ADM to break the capsule and prevent the reformation of that tight capsule. More significant long term clinical studies are needed to validate early successful cases.

If you are seeking an experienced plastic surgeon in the Miami area, Dr. Tal Roudner has the knowledge, skills, and experience you need to correct the issues related to capsular contracture and help restore your confidence in the way you look.

Request a Consultation