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Capsular Contracture rates reduced by mesh or ADM? Summary of current thought.

Home/Blog/Capsular Contracture rates reduced by mesh or ADM? Summary of current thought.

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Posted on April 22, 2026

What is capsular contracture?

I saw a patient today with capsular contracture and her implants were only a year old. She wants it fixed. I did not do her original surgery.

What is capsular contracture? It is when your “implant turns hard.” Your body has a reaction to the foreign object (here your breast implant) and forms a balloon of scar around it to separate the breast from your body. Everyone with an implant has a capsule. We grade it on a scale of I – IV, with IV being rock hard and distorts the breast shape. Frequently this is seen as a narrow, high implant with unnatural shape in the cleavage area.

People fix capsular contractures because it is not like the other side, it hurts, you can’t lie on your tummy or hug people, and it can signal other issues (implant leak, biofilm, breast implant illness). The likely etiology for capsular contracture is biofilm, a low grade infection. PREVENTION IS KEY. It is why I have a 14 point plan of things I do with every breast augmentation to try to avoid this. PLAN

What is ADM? Mesh?

ADM = acellular dermal matrix. This can be derived from human cadaver dermis or pig dermis. Brands= Alloderm, Strattice

MESH= a man made polymer of mesh.  Brand = Galaflex

ADM or mesh are used in breast surgery for a multitude of reasons. It can help reinforce thin tissue, gradually replaced by your body’s own tissue. Uses are to fix:

It is this last point I want to address here. Does it reduce capsular contracture?

What do studies show? Should you use ADM or mesh to prevent capsular contracture?

SUMMARY: The results are mixed.

There are for sure studies that show ADM reduces capsular contracture, particularly in breast cancer reconstruction with implants. Synthetic mesh data is more limited, but studies show benefit in revision cases. No studies have shown need in routine first time breast augmentation.

Why do they think it works? They think the ADM causes an alteration in collagen deposition patterns, lower myofibroblast formation, and decreased inflammation. All of these cause the capsule scar tissue to be softer and thinner.

ADM Studies showing benefit:

Mesh Studies showing benefit:

Studies Showing Limited/No Benefit:

In the analysis, a great point was made. Many of these studies are in breast cancer reconstruction or the implants are subglandular (ie in front of the pectoral muscle, not submuscular). SUBGLANDULAR PLACEMENT IS A KNOWN RISK FACTOR FOR CAPSULAR CONTRACTURE. “It is unclear whether ADM or mesh can fully reduce the baseline increased risk in primary aesthetic breast augmentation cases.”

Dr. Greenberg’s thoughts on mesh and capsular contracture

I think this deep dive confirmed my understanding that the results are mixed. For sure there is no missive to use ADM or mesh in a first time cosmetic breast augmentation, whether in front of or behind the muscle. I did this deep dive for this patient as I wondered if my understanding was up to date. Were there new clarifying studies? Should you use ADM or mesh for a breast implant revision?

That is the crux of it. There is no clear answer.

I reviewed with this patient what did your doctor do prior to your surgery and during your surgery to prevent biofilm and capsular contracture? Things like skin preps before surgery, Keller funnels, post operative Singulair have all been shown to help.

The biggest issue for her is likely the placement of the implant in front of the muscle. She is adamant to not change that.

So this comes down to a choice you get to make with me, your plastic surgeon. You are intelligent. You can read the studies cited to see the data. The data is inconclusive. So the question is what do YOU want to do? Do you want to feel like you did everything you could? Do  you want to change the plane of the implant? Do you mind the cost of the ADM or mesh? Which of those do you want to try?

I am here to help you navigate. I have used all of these products. But the final choice is yours.

Medical citations


The information provided on this website is for general informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always seek the advice of a qualified healthcare provider for any questions regarding your health or medical condition.

This blog has been authored by Dr. Lauren Greenberg

Dr. Lauren Greenberg is a Stanford-trained, board-certified plastic surgeon who brings over two decades of experience and a strong commitment to natural-looking results. She is known for combining advanced techniques with an honest, thoughtful approach to help patients feel confident and empowered.

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