Capsular contracture and the armpit route: what the evidence says

What drives contracture

The leading theory is low-grade bacterial contamination of the implant surface (biofilm) at the time of surgery, plus bleeding and inflammation in the pocket. Routes that pass through breast ducts expose the implant to the breast's own bacteria; routes that stay outside the gland don't. Hand contact with the implant, prolonged pocket exposure and haematoma all add.

Where the armpit route sits

Outside the gland, like the fold. Older transaxillary series — blunt dissection, hand-inserted implants, textured devices — reported higher complication rates; modern endoscopic series with funnel insertion and irrigation do not show a consistent penalty versus the fold. The periareolar route, through the ducts, carries the higher consideration in most analyses.

What actually matters

Sub-muscular or dual-plane placement; funnel delivery without hand contact; antibiotic irrigation of the pocket; careful haemostasis under the endoscope; smooth implants; and a short, clean operation. These are technique choices made by the surgeon, by any route — ask about each. The risks page covers treatment when contracture does occur.