CONTRACTURE?

WHAT CAUSES CAPSULAR
Unfortunately, there is no one single explanation or cause of capsular contracture. In fact, despite numerous detailed studies, capsular contracture remains poorly understood. However, all of the scientific research done over the past several decades has shed some light on capsular contracture and there are some theories to help explain why it sometimes happens. It is important to remember, as one reviews these theories, that many cases of capsular contracture can happen without any apparent cause. 
WHAT CAUSES CAPSULAR CONTRACTURE?

One possible cause of capsular contracture is the presence of excess blood in the breast pocket. This usually occurs during the initial surgery. If there is an excessive amount of bleeding, or the blood that collects in the breast pocket is not removed or cleaned out prior to inserting the implant, this excess blood can stimulate the inflammatory process that leads to capsular contracture.

EXCESSIVE BLOOD IN THE BREAST POCKET
PRESENCE OF BACTERIA IN BREAST POCKET OR ON THE BREAST IMPLANT
There are many studies which show that the presence of bacteria on the implant or in the breast can cause capsular contracture. The presence of even a few bacterial cells (which would not cause any infection) may lead to an inflammatory process that results in capsular contracture. This is called a "subclinical" infection because the amount of bacteria involved is so small ("sub") that there will not be an infection visible ("clinical"). The theory is that these few cells of bacteria in the breast pocket and on the implant produce a thin film of molecules on the implant surface called a "biofilm". The biofilm may be responsible for setting off the process that leads to capsular contracture. 
 
There are many things Dr. Diaz does to prevent the chance of bacteria contaminating the breast pocket or breast implant during surgery. One thing is to use an inframammary incision (under the breast). This incision avoids the nipple and areola, as well as the underarm area, which are areas that are normally covered and filled with a large amount of bacteria. 

Another stratgey Dr. Diaz uses to prevent bacteria from contaminating the implant is to wash the breast skin very carefully at the start of the surgery and again right before he inserts the implant. The antibiotic solution is dark in color. This step ensures that the skin in the area is as sterile as possible. 

Dr. Diaz also washes his gloves thoroughly with an antibiotic solution before handling the implant. This ensures there is no contamination of his gloves.

Lastly, Dr. Diaz uses a "No Touch" technique to insert the implant. This means he does not touch the implant during the surgery, therefore keeping it perfectly sterile. After opening the implant package, the implant is carefully placed inside a Keller Funnel. The Keller Funnel is then used to insert the implant into the breast. 

This is a picture of the implant package immediately after it has been opened.

This picture shows the implant being immediately placed into the Keller Funnel. These steps prevent contamination of the implant. 

Very few surgeons take as many steps as Dr. Diaz does to prevent capsular contracture. This is why he has one of the lowest rates of capsular contracture of any surgeon in the world. 

This picture shows Dr. Diaz inserting the implant using the Keller Funnel. 

This shows the breast immediately after the implant is inserted. 

It is important to remember that capsular contracture may also occur for unknown reasons. It does not mean that the person must have had bacterial contamination. This is just one theory as to why it may occur. 

This is a picture of Dr. Diaz's technique. When the finger is removed, you can see there is no blood whatsoever on the glove. The breast pocket is meticulously dissected and there is no bleeding present.

AND WHAT CAN BE DONE TO PREVENT IT

Capsular contracture may also be caused by a hematoma. A hematoma is a collection of blood that forms after surgery. When it occurs, the breast becomes very swollen and painful. Once this happens, surgery is required to remove the blood. Studies show an increased risk of capsular contracure if someone develops a hematoma after breast surgery. 

If someone develops capsular contracture, it does not mean that they must have had excess bleeding or a hematoma. Capsular contracture is sometimes caused by unknown reasons. This is just one theory, of many, that may explain some cases of capsular contracture. 

 

Dr. Diaz prevents bleeding during breast surgery through his careful and meticulous operative technique. You can see this in the pictures above. You can also click on his video at the bottom of this page to see how carefully he performs a breast augmentation. 

MICROSCOPIC CONTAMINATION OF BREAST POCKET

Another theory is that contamination of the implant, or of the breast, with very small or microscopic particles can lead to capsular contracure. These particles may be particles in the air, or fibers from the drapes, towels and sponges used during surgery. The presence of these particles may stimulate an inflammatory reaction in the breast which may ultimately lead to capsular contracture. 

 

Dr. Diaz prevents contamination of the implant and of the breast by employing the numerous special techniques described above. 

 

Just because a patient develops capsular contracture, it does not mean that there must have been contamination of the breast or implant. Capsular contracture is also caused by unknown reasons. 

INJURY TO MUSCLE AND BREAST TISSUES 

Dr. Diaz is meticulous in surgery and handles the tissues in the most gentle way possible. You can click on the video to see Dr. Diaz's precise technique of breast augmentation. 

Another theory is that rough handling of the breast tissues and/or muscle may lead to capsular contracure. If the dissection is not meticulously performed, there could be unintentional injury to the muscle or the breast tissue. Most of the time, this minor "bruising" does not result in capsular contracture or other complications. However, it is possible that it can lead to inflammation which can stimulate the formation of capsular contracture.

 

If someone develops capsular contracture, it does not mean that their tissues must have been handled roughly. Capsular contracture can also happen for unknown reasons.

 

 

OTHER THEORIES 

Many patients will ask if capsular contracture was caused by their body "rejecting" the implant. This does not happen. There is no evidence of an immune system reaction to the implant. There is also no evidence of the body "rejecting" the implant. This is a misconception. 

 

The silicone in a breast implant is an "inert" material. This means that the body does not form an immune reaction to it. Capsular contracture represents an inflammatory process, not an immune system reaction. 

 

Complications after breast surgery, such as the need to remove the implant, can occur. However, this is caused by things such as excess bleeding, infection or severe capsular contracture. It is not a result of the body's immune system "rejecting" the implant. 

Capsular contracture remains a poorly understood complication after breast surgery. There are several theories as to what can cause it. These include excess blood in the breast pocket, the presence of bacteria in the breast or on the implant, contamination of the breast or implant with microscopic particles and rough handling of the breast tissues and muscle. 

 

Patients can develop capsular contracture even when there is no evidence of bleeding, bacteria, contamination or rough handling of tissues. Therefore, there may be, as of yet, unknown reasons why capsular contracure may occur.

 

SUMMARY