What Causes Capsular Contracture?

Capsular contracture is caused by anything that leads to inflammation of the capsule, which causes the capsule to thicken and tighten. This complication can occur with saline implants or silicone implants. The cause of capsular contracture varies from patient to patient, and more than one cause may be present in one person. Common reasons include trauma or hematoma (bleeding) around the implant from the initial breast augmentation surgery, bacterial infection and biofilms (a film of cells that grow on inert surfaces), ruptured silicone or remnants of silicone from an old rupture, or patient reactivity to a foreign body. Dr. Cassileth finds that biofilms are more frequently the cause of contracture than initially thought, with as many as half of all contractures associated with biofilms.

Imagine the capsule as a net that contracts and tightens. If the inflammation doesn’t go away or worsens over time, the net gets tighter and tighter. Eventually, the net shrinks to the same size as the implant, trapping the implant so that it can no longer move within the net, becoming hard and immobile.

1. Removal Of The Implant And Capsule

During the capsular contracture surgery, Dr. Cassileth will carefully remove the complete capsule. This can be done with the entire implant still inside the capsule, called “en bloc” capsulectomy, or the capsule can be removed after the implant, called “complete capsulectomy.” Partial removal of the capsule, sometimes called capsulotomy, is not sufficient to cure capsular contracture.

After the capsule is removed, it is biopsied and sent to a pathology lab to test for biofilms, which are low-grade bacteria that live on the surface of the implant and can cause contracture. Dr. Cassileth then looks for any adjacent silicone leakage or other abnormalities in the surrounding breast tissue. All abnormal breast tissue must be removed, but all normal surrounding tissue should be preserved. Next, she uses an antibiotic power-wash to combat potential sources of infection, including biofilms. Finally, an anti-bacterial solution is left within the breast to complete the eradication process.

In your initial consultation, Dr. Cassileth will determine your likelihood of carrying a biofilm. Biofilms are much more likely to be present in patients with capsular contracture.¹

Likely biofilm carriers are:

• Unilateral contracture patients (only one side affected)
• Patients who had contracture following breastfeeding
• Patients with a low-grade infection following their initial augmentation
• Patients who have contracture following dental cleaning or illness.

Biofilm carriers may be more likely to have Bii (Breast implant illness).

2. The Internal Bra

Once the implant and capsule have been removed, Dr. Cassileth creates an internal bra with acellular dermal matrix (ADM). This biomaterial sheeting resists contracture and provides a protective layer between the breast and the implant. The ADM allows the body’s natural reaction to occur: a healthy capsule can form around a new implant and fuse with the ADM, keeping the pocket soft and pliable. It also supports the implants and keeps your breasts in the ideal shape and position. The presence of the ADM further decreases the recurrence rate.

3. Treat Any Infection

After your procedure, you will be kept on antibiotics until the biopsy test results are received from the lab. If bacterial growth is detected, Dr. Cassileth will send you for a consult with an Infectious Disease specialist. You will begin a course of antibiotics tailored to the results of your microbiology tests. If your results are negative (no infection), you will undergo a shorter course of prophylactic antibiotics. Patients at high risk of biofilm, those with unilateral contracture, for example, are often kept on a one-month course of antibiotics as it is common to receive positive test results for biofilms two and even three weeks after the surgery.