Capsular Contracture: Prevention, Symptoms, and Treatment

Capsular contracture is the most common complication after breast augmentation, affecting a small percentage of patients. Understanding this condition helps you recognize symptoms early and make informed decisions about treatment.

What Is Capsular Contracture?

When a breast implant is placed, the body naturally forms a thin layer of scar tissue around it—this is called the capsule. In most cases, this capsule remains soft and flexible. However, in some patients, the capsule tightens and hardens, squeezing the implant. This is capsular contracture.

Important to Know:

• The capsule itself is a normal response to any implanted device
• Only when it tightens excessively does it become problematic
• It can occur on one or both sides
• It may develop months or years after surgery
• Modern techniques have reduced its occurrence

Baker Classification System

Capsular contracture is graded using the Baker Scale:

Grade I - Breast looks and feels natural - Capsule is soft - This is the goal of augmentation - No treatment needed

Grade II - Breast feels slightly firmer than normal - Appearance remains natural - Minor contracture present - Often monitored without treatment

Grade III - Breast feels firm - Appearance is abnormal (distortion visible) - Implant shape may be apparent - Treatment usually recommended

Grade IV - Breast is hard and painful - Significantly distorted appearance - May feel uncomfortable - Treatment strongly recommended

Symptoms to Watch For

Be alert to these potential signs of developing capsular contracture:

Early Signs

• Increased firmness in one or both breasts
• Subtle change in breast shape
• Feeling of tightness

Progressive Signs

• Noticeably harder breast
• Visible distortion or abnormal contour
• Breast appears more round or ball-like
• Implant seems to ride higher

Advanced Signs

• Pain or discomfort
• Significant asymmetry
• Clearly abnormal appearance
• Chronic discomfort or aching

What Causes Capsular Contracture?

The exact cause isn't fully understood, but several factors are implicated:

Bacterial Contamination (Biofilm)

Research increasingly points to low-level bacterial contamination as a primary cause. Bacteria can form a "biofilm" on the implant surface that triggers excessive scar formation.

Hematoma or Seroma

Blood or fluid collection around the implant may increase risk.

Implant Placement

Submuscular placement (under the muscle) shows lower contracture rates than subglandular placement.

Implant Surface

Historically, textured implants showed lower contracture rates. However, concerns about BIA-ALCL have shifted preferences toward smooth implants with other preventive measures.

Individual Factors

Some patients may have genetic predisposition to excessive scar formation.

Prevention Strategies

Modern techniques significantly reduce capsular contracture risk:

Surgical Technique

• "No-touch" technique minimizing implant handling
• Keller Funnel® for implant insertion
• Antibiotic irrigation of the pocket
• Meticulous hemostasis (bleeding control)
• Submuscular placement when appropriate

Perioperative Measures

• Antibiotic prophylaxis
• Careful aseptic technique
• Limiting implant exposure time
• Nipple shields to prevent contamination

Postoperative Care

• Following all care instructions
• Breast massage (when recommended)
• Wearing supportive garments as directed
• Attending all follow-up appointments

Treatment Options

Treatment depends on severity and patient preferences:

Non-Surgical Approaches (Limited Effectiveness)

Massage and Compression

May help maintain softness but rarely reverses established contracture.

Aspen Therapy

Ultrasound-based treatment showing some benefit for mild cases.

Medications

Leukotriene inhibitors (Zafirlukast, Montelukast) and Vitamin E have been tried with mixed results. These are off-label uses.

Surgical Treatment

For Grades III and IV, surgery is typically the most effective approach:

Capsulotomy

• Incisions made in the capsule to release tightness
• Less invasive than capsulectomy
• Higher recurrence rate
• May be appropriate for mild contracture

Capsulectomy

• Complete removal of the scar tissue capsule
• More definitive treatment
• Lower recurrence when combined with other measures
• Standard approach for significant contracture

En Bloc Capsulectomy

• Capsule and implant removed together as one unit
• Capsule is not opened
• Often requested by patients with ruptured silicone implants

Implant Replacement

Typically combined with capsulectomy:

• New implants placed in fresh pocket
• May change to different implant type
• May change placement (e.g., switch to submuscular)
• May add acellular dermal matrix (ADM) for support

Autologous Reconstruction

For patients who no longer want implants:

• Implants removed permanently
• Fat transfer may add modest volume
• Eliminates future implant-related complications

Recurrence Risk

Capsular contracture can recur after treatment. Strategies to reduce recurrence:

• Complete capsule removal (capsulectomy over capsulotomy)
• Changing implant pocket location
• Using ADM for additional support
• Addressing any identified contributing factors
• Meticulous surgical technique

Recurrence rates are generally lower when addressing the underlying cause, using complete capsulectomy, and employing preventive measures.

When to Seek Evaluation

Contact your plastic surgeon if you notice:

• Changes in breast firmness
• Development of asymmetry
• Alteration in breast shape
• New discomfort or pain
• Any concerns about your implants

Early evaluation allows for more treatment options and typically better outcomes.

The Bottom Line

While capsular contracture remains a possibility with any breast implant, modern surgical techniques have significantly reduced its occurrence. If it does develop, effective treatment options exist. The key is prompt recognition and consultation with an experienced plastic surgeon who can recommend the most appropriate approach for your situation.