COVID-19-Related Immune Activation and Capsular Contracture: A Cohort Study of Infection, Vaccination, and Explantation.

Publication date: Jul 01, 2026

Capsular contracture, a prevalent complication following breast augmentation, is characterized by pain, implant distortion, and often necessitates explantation. While its multifactorial pathogenesis involves bacterial biofilms and implant characteristics, the influence of immune activation, particularly in the context of COVID-19 infection and vaccination, remains underexplored. Growing evidence suggests COVID-19 vaccination can trigger immune-mediated reactions, including delayed inflammatory responses to dermal fillers. Given that capsular contracture is a fibro-inflammatory response, this study investigated whether COVID-19-related immune activation influenced the time from breast implantation to explantation due to severe capsular contracture. This retrospective cohort study analyzed patients from a single private practice who underwent breast implant removal due to Baker grade III or IV capsular contracture. Two historical cohorts were compared: Cohort 1 (pre-pandemic: January 2016 – December 2019) and Cohort 2 (post-pandemic: January 2021 – December 2024). The primary outcome, time from implantation to explantation, was analyzed using Kaplan-Meier survival curves, log-rank tests, and a multivariate Cox proportional hazards model, adjusting for confounders. Ethical approval was obtained (CAAE: 35154720. 2.0000. 5330). A total of 115 patients were included (47 in Cohort 1, 68 in Cohort 2). Baseline characteristics were comparable between groups. The time from breast implantation to explantation due to Baker grade III/IV capsular contracture was significantly shorter in the post-pandemic cohort (4. 9 +/- 1. 3 years) compared to the pre-pandemic cohort (8. 2 +/- 1. 5 years, p 

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Original Article