Capsular contracture (CC) is a complication of breast implant surgery where the body’s natural response to the implant—the formation of a scar tissue capsule—becomes exaggerated. This capsule hardens and tightens around the implant, leading to firmness, distortion, and potential discomfort in the breast. Experiencing CC once significantly increases the risk of recurrence during any subsequent revision procedure compared to a first-time augmentation. Understanding this elevated risk and the specific measures available to counteract it is necessary for anyone considering revision surgery.
Statistical Risk of Capsular Contracture Recurrence
The chances of capsular contracture recurring after revision surgery are notably higher than the risk associated with a primary augmentation. While the initial risk for a first-time procedure is often cited in single-digit percentages, the recurrence rate following a revision for CC generally falls between 25% and 40% in many studies. This broad range suggests that specific surgical techniques and patient factors play a significant role in the final outcome.
The severity of the initial contracture influences the likelihood of it returning. CC is classified using the Baker Grade system, ranging from Grade I (soft, normal) to Grade IV (painful, hard, and distorted). Higher Baker Grades (III and IV) indicate a more aggressive biological response, translating to a higher potential for recurrence without proactive surgical measures.
The context of the original surgery matters, as revision procedures following implant-based breast reconstruction often carry a higher contracture rate. These cases may involve prior radiation or tissue manipulation, resulting in rates reported around 10.4% at three years, compared to cosmetic augmentation revisions.
Recurrence requires a comprehensive approach addressing all known risk contributors. Modifiable patient factors, such as smoking, increase the risk of contracture formation and recurrence. Complications like a hematoma (blood collection) or seroma (fluid collection) during initial recovery also raise the risk for future contracture. Studies using modern techniques have reported recurrence rates as low as 3.4% in revision cohorts, highlighting the impact of advanced strategies.
Surgical Techniques to Lower Future Risk
The most definitive action taken during revision surgery to reduce recurrence is the complete removal of the existing scar tissue capsule, known as a total capsulectomy. This procedure is necessary because the capsule is composed of reactive, fibrotic tissue prone to re-contracting. Studies show that performing a total capsulectomy results in a significantly lower rate of recurrence compared to a partial removal, such as an anterior capsulectomy.
Another powerful surgical strategy involves changing the location of the implant pocket. If the original implants were placed above the chest muscle (subglandular), moving them partially or fully beneath the chest muscle (submuscular) is strongly recommended. The submuscular position is associated with a lower incidence of capsular contracture, likely due to better tissue coverage and less exposure to breast gland tissue. Placing the new implant in a different tissue plane, often called a “pocket change,” helps distance the implant from the compromised original tissues.
The choice of implant surface is also a consideration. Textured implants were historically used to disrupt scar tissue organization, but safety concerns have led many surgeons to prefer modern, smooth-surfaced or microtextured implants combined with meticulous technique. The overall surgical approach must also prioritize minimizing tissue trauma and bleeding, as blood accumulation around the implant pocket is a known inflammatory trigger for contracture.
Post-Operative Strategies for Prevention
After revision surgery, patient-managed care and pharmacological support are important for maintaining the surgical result and preventing the re-tightening of the new capsule. The most common non-surgical intervention is the consistent use of massage protocols. The purpose of implant massage is mechanical, aiming to keep the developing scar tissue loose and pliable and prevent the formation of a rigid capsule.
Surgeons often recommend a specific schedule, such as massaging the implants for three to five minutes, two or three times a day, particularly during the first few months. These exercises involve pushing the implant in different directions to ensure it remains freely mobile within the pocket, optimizing long-term softness. The exact technique and duration should be guided by the performing surgeon’s instructions.
Pharmacological interventions are another important tool, though they are considered off-label and require a physician’s guidance. Medications known as leukotriene receptor antagonists, such as Montelukast or Zafirlukast, may be prescribed to reduce the inflammatory response that drives scar tissue formation. These medications block chemical pathways that activate fibroblasts, the cells responsible for producing the contracting collagen fibers of the capsule. Evidence suggests these antagonists can be effective in preventing CC, but their use must be weighed against potential side effects.
Meticulous infection control during and after the procedure is essential, as subclinical bacterial contamination (biofilm) is considered a primary driver of contracture recurrence. This includes prophylactic antibiotics before the procedure and the use of antiseptic solutions to irrigate the implant pocket during surgery. Minimizing the risk of hematoma or seroma formation through surgical drains and careful tissue handling further reduces the potential for an inflammatory cascade that could stimulate recurrence.