The Holy Grail of Plastic Surgery
Capsular contracture is one of the most common complications following breast augmentation surgery. It occurs when the body forms a thick, fibrous capsule around a breast implant. While some scar tissue formation is a normal part of the healing process, in capsular contracture, this tissue becomes unusually dense and begins to contract, leading to hardening, breast distortion, pain, and tenderness. In more advanced cases, it can cause significant discomfort and affect the appearance of the breast.
The exact cause of capsular contracture remains unclear, but leading theories suggest that the presence of bacteria within the implant pocket may play a role. Even non-pathogenic bacteria—the type you find on your skin and don’t cause infection—can stimulate an immune response. When the body recognizes these bacteria, it may interpret the implant as a foreign object, triggering inflammation and an aggressive scarring process around it.
Other contributing factors include:
The result is an overactive healing response, leading to the formation of a tight, constrictive capsule around the implant.
Surgical drains help reduce blood accumulation in the chest cavity, which is crucial because blood is an ideal medium for bacterial growth. While surgeons can control active bleeding from vessels, microscopic capillary leakage is unavoidable. Drains left in place for 2–5 days after surgery significantly reduce the risk of capsular contracture by minimizing bacterial colonization within the implant pocket.
The Keller Funnel enables a “no-touch” technique during implant insertion, reducing the chances of bacterial contamination. The moment an implant is removed from sterile packaging, it’s at risk for exposure—even in a clean surgical environment. Using the funnel eliminates unnecessary handling and limits implant contact with the skin or gloves. A 2018 study published in Plastic and Reconstructive Surgery found that the use of the Keller Funnel reduced the rate of capsular contracture by 87%.
It also allows larger implants to be inserted through smaller incisions, which improves aesthetic outcomes and reduces implant trauma.
Zafirlukast (brand name Accolate) is an anti-inflammatory medication originally used to treat asthma, but it’s been repurposed in plastic surgery to reduce the risk of capsular contracture. It works by blocking leukotriene receptor antagonists—compounds involved in the immune system’s inflammatory response.
Daily use of zafirlukast for 90 days after augmentation has been shown to reduce the risk of excessive capsule formation. It has minimal side effects and has been used safely in plastic surgery for over 20 years. For more information on its effectiveness in preventing capsular contracture, please read my 2002 study.
Beyond the initial 90-day postoperative window, the immune system may become activated at other times, such as when fighting off a cold or other illness. This systemic response can also trigger inflammation around an implant. In such cases, reintroducing zafirlukast for a short course can help suppress inflammation and prevent capsular changes.
Even after the initial post-op period, your body can mount an immune response that impacts your breast implants. Events such as illness, injury, or stress can trigger systemic inflammation, potentially reactivating capsule formation around the implant.
If you’ve previously taken zafirlukast to prevent capsular contracture, consider reintroducing a short course during any period of immune activation. This helps reduce inflammation around the implant before it can progress to myofibrosis. Always consult your surgeon before resuming the medication, but having zafirlukast on hand can be a powerful preventative measure for long-term implant health.
While visits to the dentist are absolutely necessary, they increase your likelihood of developing capsular contracture if you do not prepare accordingly. This is because dental work creates an entry point for bacteria to enter a patient’s bloodstream through the mouth, which can trigger an inflammatory response similar to that caused by vaccines and tattoos. Instead of zafirlukast, I always recommend that my patients take an antibiotic, such as amoxicillin, one hour before visiting the dentist. Antibiotics create a neutral environment in your mouth, preventing bacteria from thriving.
When your body is fighting off an illness, such as the flu, a cold, or any other viral infection, your immune system goes into high alert. This systemic activation can inadvertently target your breast implants, mistaking them as foreign threats and triggering inflammation in the surrounding capsule.
If you feel yourself coming down with something, don’t wait it out. See your doctor early and start a targeted treatment plan. In some cases, a short course of antibiotics or anti-inflammatory medication, such as zafirlukast, can help regulate your immune system and prevent the onset of capsular contracture. The goal is to interrupt the inflammatory cascade before it can affect the implant pocket.
Once capsular contracture is confirmed, there are four primary management paths depending on severity, patient symptoms, and ultrasound findings:
As with any diagnosis, you have the option to take no action; however, we recommend monitoring. In mild or asymptomatic cases, no immediate intervention may be necessary. Patients can be monitored over time with routine ultrasound imaging and physical exams to track any progression.
If bacterial colonization is suspected but not severe, a targeted treatment protocol may be initiated. This often involves a combination of oral antibiotics and anti-inflammatory medications, such as zafirlukast, to control the immune response and prevent further capsule formation.
For moderate cases, ultrasound-guided injection therapy may be used. This involves delivering medications such as platelet-rich plasma (PRP) directly into the capsule to reduce inflammation and soften the tissue.
In advanced or recurrent cases, surgical correction may be necessary. This can include a capsulectomy (removal of the capsule) or implant exchange. Patients should be referred only to board-certified plastic surgeons with experience in revision breast surgery to ensure optimal outcomes.
The most important step you can take in preventing capsular contracture is to choose a board-certified plastic surgeon for your breast augmentation. They will possess the experience, knowledge, and skills required to deliver beautiful, natural-looking results and help prevent capsular contracture. In addition to having over 30 years of experience performing these surgeries, Board-certified plastic surgeon Dr. S. Larry Schlesinger has published landmark research on capsular contracture in 2002, which popularized the use of zafirlukast and therapeutic ultrasound treatments.
If you’re considering treatment for capsular contracture, Board-certified plastic surgeon Dr. Schlesinger and his team in Honolulu, HI, are here to guide you every step of the way. Dr. Schlesinger has over 30 years of experience, and in 2002, he published landmark research on capsular contracture that popularized the use of zafirlukast and therapeutic ultrasound treatments. Schedule your personalized consultation today and begin your journey toward restored comfort, confidence, and beautiful results. Your path to feeling like yourself again starts now.