Our current theory on the main cause of capsular contracture (hardening of the breasts after breast augmentation) is that of a 'Biofilm' as a causative agent. This is a low population "infection" that hangs out on the surface of the implants and secretes a mucous layer that protects the bacteria from getting destroyed by the bodies defenses. The number of bacteria is so low that it rarely leads to frank infection but still causes the body to try to protect itself by walling it off. This in effect causes the naturally thin interface between the body and the implant to thicken and eventually tighten.
Many causes have been attributed to causing this. Among these infection, hematoma, early sun burn, leaking or ruptured implants, etc. These factors do have something to do with it but themain culprit seems to be the "Biofilm". The 'no touch' insertion technique has long been touted as the best way to prevent this contamination that seems to occur as the surface of the implant comes into contact with the skin surface (even after the skin has been treated with an antiseptic scrub). Until now the ' no touch' was easier said than done especially when I was putting large implants through small incisions. This could explain the small but significant difference in the capsular contracture with saline implants compared to silicon implants. The saline implants are placed empty and have minimal contact with the skin upon placing the implant into its final resting pocket.
The addition of a triple antibiotic wash has been quite helpful in minimizing the capsular contractures.. but the real breakthrough in my practice came about 9 months ago when I began using the Keller Funnel in all my silicon breast augmentations. This is a simple sterile paper delivery system that looks like a pastry bag. Much faster placement of the implants without them coming in contact with this skin. there is much less trauma to the implant and the skin in the process! I decided not to pass the cost of this device onto my patients since eventually I would benefit from not having to treat and often re operate on these hard breasts.