How common is repeat capsular contracture when replaced with smaller implant after total capsulotomy?

Hey there.

Thank you so much for this question. Capsular contracture unfortunately is a known complication of breast implant surgery occurring 1% per year for a patient. In your case the risk would be 1%. Patient risk factors typically include any nicotine usage. The exact etiology is unknown but the most commonly accepted cause is bacterial colonization of the implant leading to the encapsulation. The most common treatment is implant exchange and 'pocket change'; meaning if you are on top of the muscle placing the implant below the muscle, or if you are below the muscle making a neosubpectoral pocket (new submuscular pocket). The site change is key as it helps to place the implant away from the presumed bacterial source.

In our practice we also are sure to copiously irrigate the pocket with several different antibacterial solutions to cleanse the area.

I would advise to make sure you are consulting with a board certified plastic surgeon who specializes in aesthetic surgery; a member of the Aesthetic Society illustrates this fact.

Thank you again for your question and best of luck.

Capsular contracture may occur for various reasons such as sub-clinical bacterial contamination of the implant during placement, oversized implants for the breast pocket, genetic predisposition, and others. Overall, the rate of capsular contracture is approximately 1% per year. To minimize a patient's risk of developing capsular contracture, I recommend an inframammary incision (vs periareolar or axillary/armpit), submuscular implant placement, use of an implant funnel/no-touch technique, atraumatic technique, and aseptic pocket wash among other technical considerations. Once a contracture has developed, the best technique to reduce the risk of recurrence is to remove and replace the implant in a new plane.