In Dr. Tehrani’s practice, capsular contracture happens to only 5% of patients. In most cases, it happens during the first 3 months and is treated instantly. Here’s how our surgeon minimizes the risk.
No matter how skilled your plastic surgeon, some breast augmentation surgeries lead to capsular contracture. Everyone’s bodies react differently to the foreign objects inside their breasts. For most patients, the connective tissue heals nicely and does not lead to any complications. For some, however, side effects may surface.
There are many great examples of how differently patients can go through surgery. Some patients’ bodies form thick scar tissue after the operation, while most can take on even major surgeries without having to deal with scars later on—even if they do, these scars tend to fade away over time.
Another case where women tend to react very differently to their bodily changes is pregnancy. While some will develop significant stretch marks—seemingly no matter what they do—others will go through the whole journey without significant stretching.
Complications in plastic surgery are extremely rare. Better diagnostic processes allow surgeons to foresee potential complications and qualify patients more accurately. Improved surgical tools and techniques enable them to make more accurate incisions which lead to fewer side effects and less scarring.
For example, we now know for sure that overweight patients are linked to higher complication rates. Therefore, patients with weight problems are often advised against surgery.
Patients prone to forming thick scar tissue after incisions might undergo an alternative incision method—for example, the surgeon may insert the implants through an incision in your underarm, where the scars are very easy to hide.
Patients with autoimmune system disorders or diseases are often advised against plastic surgery of any sort.
What Is Capsular Contracture?
Scar tissue forms after a breast augmentation procedure is complete—that’s a natural part of the process. Your body reacts automatically to a foreign object inside the breast, forming a thin barrier around the implant—the “capsule”—isolating it from the rest of the body.
While this is a defensive mechanism, it usually benefits the patient. The pocket surrounding the implant helps keep it in place, contributing to a symmetric appearance.
In rare cases, however, the capsule becomes unnaturally hard and tightens around the implant. This is called capsular contracture.
“Capsular contracture is uncommon,” says Dr. Tehrani. “Nationally, it could be up to 20-25%. My practice is closer to 9%. We do a lot of things to minimize that.”
Capsular contracture can both cause visual problems (the breasts may look uneven when the pocket contracts) and, in extreme cases, even physical sensations of pain. Most capsular contractures are mild and patients go on for months and even years without ever noticing anything strange about their breasts.
There are four grades of severity to capsular contracture.
Grade 1 capsular contracture is quite common and is usually symptomless. The capsule around the implant does not alter its shape, size or position. The breast feels soft and normal to the touch.
Grade 2 capsular contracture is much less common. It surfaces as a mild hardening of the breast. The shape and size of the breast remains unchanged.
Grade 3 capsular contracture is when we start seeing significant visual changes—unsurprisingly, this is the stage of contracture patients notice most frequently. The breast becomes tender and hardened. It may look unnaturally round and the nipples may look deformed. Grade 3 contracture does not cause physical pain.
Grade 4 capsular contracture is classified as a severe hardening and deformation of the breast. This is the stage when patients feel severe pain. The breast will feel extremely tender and completely hard to the touch.
“One of the most common early signs of capsular contracture,” Dr. Tehrani explains. “Is that the implant on one breast is not coming down as fast as the implant on the other one. That’s because the capsule is starting to get hard, and when it starts getting really hard, then we have to treat it.”
Since it’s a defensive mechanism to protect your body from infection, capsular contracture occurs during the healing period. In fact, most cases (around 75%) of capsular contracture will occur in the first 2 years after the surgery. However, the reaction may occur even 5, 10 or 15 years after your breast augmentation. For late capsular contractures, a torn implant is usually the culprit.
What Causes Capsular Contracture?
While we know a lot about the natural bodily process of isolating the implant in a scar tissue pocket, surgeons cannot tell for certain why these pockets start contracting. A number of reasons can influence the hardening and deformation of the breast implant capsule, and these vary from patient to patient.
We’d like to emphasize that capsular contractures are not an indication that the implants themselves are toxic or dangerous to your body. Saline implants consist solely of salt water, which your body can safely absorb without causing any side effects. Silicone implants, similarly, are made out of medically safe silicone.
Capsular contracture can occur with any sort of implant that’s put into your body—they’re not exclusive to breasts. It’s just that due to the sensitive nature of the operation, patients are most preoccupied with breast capsular contracture in particular.
Researchers suspect that genetics may be one of the factors influencing the risk of capsular contracture. Did someone within your family tree suffer from autoimmune diseases? How about thick scar tissues? Is there a history with medical implant complications within your family history? If so, you may be more prone to face contracture yourself.
Even having access to a thorough medical history of your family, there is no way of telling for sure whether you’ll fall victim to contracture. Severe contractures that deform the breast and cause pain are extremely rare, and these cases usually respond very well to treatment. So even if there is a small risk of capsular contracture, it’s easy to fix, so you shouldn’t worry about it.
Sometimes capsular contracture is caused by a bad bodily reaction to the implant. A thin layer of bacteria—a biofilm—can form around the foreign object inside your breast. These bacteria cause a mild chronic infection, which can go for months without causing any noticeable symptoms (e.g. temperature or fatigue.)
“One of the most common hypotheses as to why capsular contractures happen,” says Dr. Tehrani. “Is that there’s a very thin film around the implant that’s caused by bacteria. It’s just the covering of bacteria that causes capsular contracture. That’s why we’re very aggressive in using antibiotics before and after the operation to minimize that.”
However, as your body battles this slow-going infection, it keeps producing scar tissue to isolate the issue, which can cause a contracture in itself. A recent medical study with pigs has reinforced the idea that the biofilm-caused infection may indeed be the primary cause for most severe capsular contractures.
The infection is not necessarily caused by unsanitary surgical conditions. Some people carry a certain type of bacteria on their skin that may make them more prone to catching an infection that may lead to capsular contracture.
There is a significant link between capsular contracture and other, more significant breast augmentation complications, such as hematomas and seromas (blood clots that form after surgery.) These complications are considered by researchers to increase the risk of capsular contracture.
So, to summarize, we do not know exactly what causes capsular contracture, but we know it’s rare and we know it can be treated quickly and effectively.
What Can Be Done to Prevent Capsular Contracture?
Due to lack of research and clinical evidence we do not know for sure how to prevent capsular contracture in every patient. However, there are proactive steps that can be taken to dramatically reduce the risk.
First and foremost, we screen patients carefully. Patients are tested for a number of health factors to establish their vulnerability towards a complication—such as a hematoma. After patients’ medical history is examined for signs of increased complication risk, we make sure they understand that smoking is strictly prohibited 30 days before and after the procedure, as it interferes with the healing processes and may contribute to an infection.
Selecting a safe implant size for the patient is also imperative. Your body may not have enough breast tissue to cover an overly large implant, which increases the risk of contracture. If a patient with small breasts wants to increase their cup size, it’s best to do it in smaller steps. For example, you could go for a medium size implant first, and then move onto a bigger one after your body adjusts and your skin stretches out.
Also, it’s a good practice to handle the implant as little as possible before inserting it into the breast. The more you manipulate it in the operating room, the higher the chance of bacteria entering the patient’s body. Board certified plastic surgeons, including Dr. Tehrani, know this and work under strict hygiene requirements.
“There are many steps that could be done to prevent capsular contracture,” says the surgeon. “One is to decrease the actual touching of the implant—it’s called the ‘no-touch’ or the ‘minimal touch’ technique—using a keller funnel to put the implant through a special sleeve.”
It has been shown that using textured gel implants—instead of ones with flat surface—can reduce the risk of capsular contracture. It is believed that implants with textured surfaces prevent too much scar tissue forming around them. However, textured implants are not viable for every patient, as they may be more noticeable around the edges, creating an undesirable appearance.
Implants can also be inserted via special “under the muscle” technique. During this surgery, as the name suggests, the implants are partially or fully placed under the chest muscle. Studies suggest this technique can reduce the risk of capsular contracture by 10-12%.
“Some incisions are worse in terms of capsular contracture,” says Dr. Tehrani. “The most common incision I use is underneath the fold below the breast—that one has the lowest rate of capsular contracture—to be followed by the incision next to the nipple, which has a higher rate. The underarm incision has the highest rate of capsular contracture.”
How Dr. Tehrani Avoids Capsular Contracture
In addition to the general guidelines listed above, Dr. Tehrani has a few tricks of his own.
The number one thing he mentions is sterility:
“Everything is sterile. Antibiotics, irrigation into the implant itself using a keller funnel to put the implant through a sleeve,” the surgeon explains. “And also, we use a special medication called Singulair to help capsular contracture not even happen.”
Has Dr. Tehrani had to deal with capsular contracture in his own patients?
“Yes, we’ve had it in our practice as well,” the surgeon says confidently. “We see capsular contracture very early. If I see it within the first month after the surgery, we continue with Singulair medication and we start the Aspen ultrasound to non-surgically treat the capsule.”
How to Deal With Capsular Contracture
If you suspect that you’re experiencing capsular contracture, the first thing you should do is set an appointment with Dr. Tehrani.
“An appointment is very necessary,” says the surgeon. “That’s why breast augmentation patients need to be seen frequently after surgery—multiple times, within weeks and months after surgery. You need to have appointments to make sure everything is okay.”
Dr. Tehrani explains that if you’re healing well during the first 3 months, the risk of developing capsular contracture after that period drops dramatically.
If you do, however:
“There is a non-surgical way to address capsular contracture,” continues Dr. Tehrani. “Which is the Aspen ultrasound. It uses ultrasonic waves to treat capsular contracture. That’s best done early.”
Final Verdict: Capsular Contracture Does Happen, but Is Rare
If you’re worried about capsular contracture, don’t be. It’s extremely rare here at Aristocrat Plastic Surgery.
A lot depends on the technique used to insert implants for each patient. Dr. Tehrani uses a special sterile technique that minimizes the risk of capsular contracture down to 5%.
Even when it does happen, it’s diagnosed early—during the first 3 months of post-op recovery. Frequent check-ups make sure we monitor the health of your breasts all the way while you’re healing up.