An extremely rare complication of breast augmentation, with silicone implant, is the creation of a shrinking capsule. The term shrinking capsule, refers to the creation of hard tissue around the implant, which has no elasticity and tends to tighten the implant, altering the shape of the breast.

Why must an implant be removed when this occurs? 

A variety of factors. The official journal of Plastic Surgery worldwide, PRS, Plastic Reconstruction Surgery Journal, has recently published the Risk Factor for Capsular Constructure, a 10 year study using round an textured implants for breast Augmentation vol 141, where the following are recommended:

  • The use of Dual Plane technique, where possible, meaning under the major pectoral muscle.
  • Avoidance of incision from the nipple – areola.
  • Minimal contact of the implant, at the time of surgery, and rinsing with an antibiotic solution.
  • Avoidance of large implants >350cc.
  • Avoidance of formation of blood or serum collection (dry case).
  • Avoid the placement of drains as they contribute to possible contamination.

The responsible causes of this situation include, hematoma, inflammation, the type of implant, but also the way the body heals. Imagine the capsule as a “net” that contracts and tightens like an inner keloid. This “net” shrinks the size of the implant, trapping it, so that it is not able to move into its “net”, as a result, hardness occurs, making the breast immobile, with an unnatural result.


STAGE A: The patient does not feel anything, only a doctor upon palpation understands a mild hardness in the chest.

STAGE B: The patient feels her breasts hard and inelastic.

STAGE C: The breast begins to change shape and becomes painful.

STAGE D: All of the above, plus that the breasts are now particularly painful.

The prevention of contracture capsule is of paramount importance.  Dr. Tzamantaki, member of ISAPS International Society of Aesthetic Plastic Surgery since 2011, follows all international rules “14 steps” to minimize the chances of postoperative complications in breast augmentation, such as the creation of a shrinking capsule.

If you think you have any of the symptoms of a contractile capsule, the first step is to get tested. After a clinical examination andappropriate U/S tests, Mammography, Breast MRI, it will be decided if and if we need to perform surgery.  In stages A & B treatment can be non-invasive, while in stages C & D, there is no other option.

The surgical treatment of the contractile capsule requires removal of the old implant along with the contractile capsule that surrounds it, Capsectomy.  Other times this is impossible to perform in the operating room due to the texture of the capsule, it is a loose bleeding tissue, so it is necessary to exclude it as much as possible and perform the so-called Capsotomy. Many times, it is necessary to change the position of the case, for example if the implant was under the gland to have to be rebuilt in Dual Plane, or under the major thoracic.  The operation should definitively solve the problem and restore an aesthetically harmonious breast without pain and deformity.

Our first appointment:

The philosophy of Dr. Tzamantaki is to provide absolute attention to your concerns and fully understand the patient’s needs. The doctor will go through all your possible options and provide solutions with all their advantages and disadvantages so that the patient is fully informed.  For example, it is not the right solution to not choose silicone implants after a patient has gone through this misfortunate incident because the breast will remain an “empty bag” and this is not an option of serious Aesthetic Plastic Surgery! The Doctor will explain how to cure this problem without creating another psychosomatic problem due to poor choice or misinformation. All surgeries include plastic surgeries can results in complications, prevention is clearly our number one priority, but if patient undergoes any sort of complications in past surgeries our team is here to provide the natural result they initially wished for.

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