Capsular contracture: what is it? What causes it? How can it be prevented and managed?

For more than 40 years capsular contracture has plagued plastic surgery as the most common complication of aesthetic and reconstructive breast surgery. This article reviews the basis for capsular contracture and defines the methods to prevent it and treat it when it occurs. Capsular contracture is most commonly a result of a subclinical colonization of the implant pocket with bacteria. Sound techniques-including precise, atraumatic, bloodless dissection; appropriate triple antibiotic breast pocket irrigation; and minimizing any points of contamination during the procedure-have produced very low capsular contracture rates. Treatment of capsular contracture is most often surgical total capsulectomy with site change when indicated and replacement with a new implant.