Renowned Capsular Contracture Treatment in Miami, Fl
Case Study: 8 Years of Recurrent Capsular Contracture Successfully Treated
Understanding Why Capsular Contracture Happens — and Why It Can Return
Capsular contracture remains one of the most frustrating complications after breast augmentation. Many of the women I evaluate have already undergone one or more corrective procedures. I just recently successfully treated a woman after 5 surgeries and eight years of a hard, painful and deformed breast. It is not an uncommon story. They describe a familiar pattern:
The breast becomes firm… then hard… sometimes painful.
The implant is replaced. The capsule is released or even removed.
The breast softens temporarily. Weeks or months later, the firmness returns.
By the time they arrive, many believe their body is simply “rejecting implants” or that they are someone who “just makes scar tissue.”
In most cases, that is not an accurate explanation.
Capsular contracture is not random. And when it recurs, there is usually a biologic or mechanical reason.
What Capsular Contracture Actually Is
Every breast implant forms a capsule.
That is normal biology.
The body creates a thin layer of scar tissue around any foreign material. In most patients, this capsule remains soft and flexible.
Capsular contracture occurs when that capsule thickens and tightens, compressing the implant. This can lead to:
- Firmness
- Distortion
- Discomfort or pain
- A less natural feel
Capsular contracture often begins to show up weeks after the initial surgery, although it may certainly appear later. Capsular contracture also may show up many years later with rupture of a silicone implant.
Initial Causes of Capsular Contracture
Capsular contracture is influenced by multiple factors, often working together:
1. Inflammation
Inflammation plays a central role in capsule formation. Excessive or prolonged inflammation can stimulate abnormal scar tightening.
Contributors may include:
- Blood remaining in the implant pocket (hematoma)
- Fluid collections (seroma)
- Tissue trauma
- Mechanical irritation
Even small amounts of retained blood can increase inflammatory signaling during healing.
2. Bacterial Contamination and Biofilm
Low-grade bacterial contamination is a well-recognized contributor to contracture.
This is not necessarily a visible infection. Microscopic bacteria can attach to the implant surface and form a biofilm — a protective bacterial layer resistant to antibiotics and difficult to detect during surgery.
Biofilm can stimulate chronic inflammation, increasing the likelihood of capsule thickening and tightening.
Simply exchanging the implant does not reliably eliminate biofilm if the surrounding capsule and pocket environment remain unchanged.
3. Individual Inflammatory Response
Some patients appear to have a stronger inflammatory or fibrotic response to foreign materials.
This does not mean their body is “rejecting” the implant, but it does mean their scar response may be more aggressive.
Variability in immune and inflammatory behavior is one reason some individuals are more prone to contracture or recurrence.
4. Mechanical and Structural Factors
Mechanical irritation in some may perpetuate inflammation and contribute to capsule thickening and tightening.
Dr. Gershenbaum’s Approach to Treating Capsular Contracture — Initial and Recurrent Cases
Over many years treating capsular contracture, I have found that addressing the implant environment is more important than simply replacing the implant and treating the capsule. If just the implant is exchanged with opening the capsule (capsulotomy) or even removing the capsule (capsulectomy), there is still an exceedingly high chance of the capsule recurring. A capsulectomy and site change from subpectoral to subglandular also has a very high chance of recurrence.
My approach — both for initial capsular contracture and for recurrent capsular contracture — centers on:
- Capsulectomy (removal of the diseased capsule)
- Careful control of bleeding and contamination risk
- Appropriate antiseptic irrigation of the pocket
- Stabilization of the implant pocket
- Biologic reinforcement using an acellular dermal matrix (ADM), such as STRATTICE™
Rather than treating contracture as a one-time complication, I treat it as a condition influenced by inflammation, structural support, and biologic response.
The Role of an ADM such as STRATTICE
In my hands, incorporating STRATTICE as part of a comprehensive surgical plan has shown to be well over 90% successful in treating capsular contracture — including recurrent cases.
According to LifeCell Corporation, which is a subsidiary of Allergan (an AbbVie company) and the National Institute of Health, STRATTICE provides:
- Structural reinforcement of the implant pocket acting as a biological barrier between the implant and surrounding tissues which is believed to reduce inflammation and fibrous encapsulation
- A more stable, collagen rich interface that reduces the accumulation of myofibroblasts responsible for inflammation, scar tissue formation and contracture
- Improved lower pole support
- Incorporation into the surrounding tissues and reduced mechanical irritation
- A more stable and controlled healing environment
- Additional tissue coverage especially helpful in thin patients after capsulectomy
When combined with complete capsulectomy, STRATTICE helps reconstruct the implant environment rather than simply resetting the same conditions that allowed contracture to develop.
When a Site (Placement) Change May Be Appropriate
On occasion, when a patient presents with capsular contracture and the implant is in a subglandular position, depending on the exam and discussion with the patient, a capsulectomy and site change to a subpectoral position may be acceptable.
In selected cases, a capsulectomy and well-executed site change may provide sufficient improvement in tissue coverage and implant environment that an ADM is not required.
Treatment decisions are individualized, based on tissue quality, implant history, and patient goals.
Why Implant Exchange or Capsulectomy Alone May Fail
Many patients I see have already undergone:
- Implant exchange alone
- Implant exchange with partial or full capsulectomy
- Capsule scoring or release
- Capsulectomy without structural reinforcement
- Implant site change
These procedures can be appropriate in selected situations. However, recurrence is unacceptably high as inflammation, biofilm, instability, or structural weakness remain.
Removing the capsule alone does not always prevent the body from recreating the same tightening response if the surrounding environment has not been fully reconstructed.
What I See in Practice
I have treated patients who arrived after multiple failed revision procedures with extremely hard, painful breasts.
Following capsulectomy and appropriate pocket reconstruction —with STRATTICE reinforcement and inteposition — these patients go on to have breasts that feel soft and natural, frequently as though the capsular contracture had never been present in the first place.
The difference is not simply replacing the implant or removing the capsule.
It is reconstructing the environment around it.
The Takeaway
Capsular contracture is driven by inflammation, biofilm, mechanical forces, and individual biologic response.
These factors need to be addressed comprehensively — using capsulectomy and most often an acellular dermal matrix (ADM) such as STRATTICE coverage and interposition.
In my experience, this reconstruction-based strategy has produced well over 90% success, including those with recurrent capsular contracture.
This information is educational and intended to explain treatment concepts. Individual evaluation is necessary to determine appropriate care.