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Breast Augmentation Complications – Capsular Contracture


No one likes to discuss possible breast augmentation complications, but it is important to inform patients of the risks and what steps can be taken to reduce the chance of these complications from happening.


Capsular contracture is a complication that can arise from breast augmentation surgery. Capsular contracture refers to scar tissue that forms around a breast implant, causing the breast to harden. This may cause the breast to look or feel different, and may result in some discomfort from the tightening of the capsule, and it may case the implant to ride high on the chest wall. There are four subjective classifications of capsular contracture according to the Baker Grading Scale: Grade I, breast is soft and looks natural; Grade II, breast is slightly firm, but looks natural; Grade III, breast feels and looks firm; Grade IV, breast is hard, painful and looks abnormal.


The cause of capsular contracture is essentially unknown, but there are external factors that can raise the risk of occurrence; including patients who are smokers, patients who choose very large implants over 500 cc, subglandular (above the muscle) placement, and patients who have developed a hematoma post surgery.


Breast Augmentation Complications & How to Reduce the Risk of Capsular Contracture

At my practice we take several steps to reduce the risk of capsular contracture. First, the majority of my breast implant procedures are placed under the muscle (submuscular), which reduces the risk by approximately 8- 12% over the patient’s lifetime. Over the muscle (subglandular) has a 10-25% chance of capsular contracture. If the implant is placed on top of the muscle, I recommend using a textured implant to help deter capsular contracture formation. The rough surface discourages a hard capsule of scar tissue from forming around the breast implant.


Second, I use sharp dissection when creating the pocket for the implant to reduce the amount of bleeding from the procedure. Using electrocautery, dissection is done with precision cauterizing the blood vessels in the area to reduce trauma and control bleeding. It has been shown that hematomas and bleeding can increase the risk of capsular contracture.

Third, I use triple antibiotic irrigation to clean the pocket before placing the implant. Capsular contracture can be attributed to subclinical infection, immunologic response to breast implants, and chronic inflammatory changes caused by the presence of the implants.


Irrigating implant pockets with a triple antibiotic solution may help reduce the risk of infection.

Fourth, I use the ‘no touch’ technique to place the implant using a ‘Keller Funnel’. The Keller Funnel is a device used to insert the implant into the pocket, lessening the trauma to the implant as it minimizes pressure on the implant shell, and thus likely extend life of the implant. The sterile package containing the implants is opened at the moment it is ready to be inserted into the body via the kennel funnel, and enters the pocket without the actual implant being touched by anyone in the operating room, reducing the risk of implant contamination. All of these measures help ensure that no foreign substance attach themselves to the implant, which could inflame the surrounding tissue and cause complications such as capsular contracture.


One month after surgery, I recommend my patients to massage their breasts to prevent scar tissue from forming around the implant. Though there are no studies proving the effectiveness of this technique, I do believe that massage can help the breasts soften post-operatively and may also help reduce swelling. A technique I recommend to help prevent a scar capsule from forming is to move your breast implant around in the surgical pocket by pushing it up and down and side to side as far as possible in the pocket. To prevent scar tissue from compressing the contents of the implant, I also recommend squeezing the implant with your fingers vertically and horizontally. Cross-fiber friction massage, which involves squeezing and rubbing across the scar tissue, may also help release adhesions in the breast tissue.


If you have any questions about capsular contracture or breast augmentation complications, schedule a free consultation by emailing me directly at DrAzad@KamranAzadMD.com.

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Copyright © 2020 Kamran Azad, MD. Azad Plastic Surgery