Every breast implant used in breast enhancement, augmentation, correction of breast asymmetry, and breast reconstruction will form a natural capsule, a kind of scar over the surface of the implant. For a very few individuals, the capsule will become tight and firm in perhaps two out of a hundred, and the implant will become round, losing its natural softness. The cause is poorly understood, and for most, the contracture happens on just one side. Despite every effort to place the implants cleanly and free of any contaminates, capsules will occur.

Once a capsular contracture has begun, our options have been medical approaches using vitamin E, Singulair™, and implant massage. The success has been poor for most. The surgical options are opening the capsule or removing it altogether, or placing the implant in a new pocket in front of or behind the old one. Surgery is successful about half of the time. Yes, the capsule will eventually return and firm up for half of breast implant wearers. Of course, the implants can be removed, but patients are so pleased with their implants that most will live with the capsule, rather than live without breast implants.

A new idea has emerged with our experience in breast reconstruction. We have trended to more breast preservation and immediate breast reconstruction after mastectomy. Patients with breast reconstruction seem to have the highest rates of a capsule or firm breast implant. However, when we place the implant immediately, and support it with an allograft, the capsular contracture rate has been less than expected. An allograft is a sheet of collagen prepared from a donor that covers and supports the implant and it may prevent the capsule from tightening. Many surgeons are now using allografts ‘off label’ with success to solve problems with capsular contracture giving new hope to those with a firm breast implant. As full studies have not been completed, the proof is yet to come. In time, the allograft may be the tool we have been looking for to solve a very difficult breast implant problem.