Capsular contracture is one of the most common long-term complications following breast augmentation (for both Saline and Silicone) and breast reconstruction with implants. While every breast implant naturally develops a thin layer of scar tissue called a capsule, capsular contracture occurs when that capsule becomes abnormally thick, tight, and firm. This can change the appearance of the breast and, in some cases, cause discomfort or pain.
What is a Capsule?
To better grasp capsular contracture, it is important to understand what a capsule is in the body. Whenever any foreign material, whether it is a breast implant, joint replacement or even a pacemaker, is placed inside the human body, there is a natural reaction to “wall off” the foreign substance. Over time, this walled off layer that envelopes the foreign material creates a thin layer of tissue that is referred to as a “capsule.”
What is Capsular Contracture?
When it comes to breast implants, sometimes this thin layer of capsule becomes thick for a variety of reasons. This can cause a spectrum of symptoms. Usually, the thicker the capsule, the more symptoms are associated with it. The reason why it is called “Capsular Contracture” is because the capsule shrivels up and contracts, making the breast implants look distorted, asymmetric, and in more severe cases, it can cause pain and discomfort. Physiologically, the chronic inflammation stimulates specialized cells called myofibroblasts, causing the capsule to contract around the implant.
What are the different grades of Capsular Contracture?
Capsular contracture is commonly classified using the Baker Grading System:
Baker Grades of Capsular Contracture
- Grade I (Normal): Breasts appears soft and feels normal.
- Grade II (Mild): Breasts appear soft but feels firm.
- Grade III (Moderate): Breasts appear firm and feel firm. Patients may have pain on palpation.
- Grade IV (Severe): Breasts appear firm, feel firm. Patients have pain on palpation and at rest.
Mild cases may simply require observation, while more advanced grades often benefit from surgical treatment.
What Causes Capsular Contracture?
The exact cause of capsular contracture remains incompletely understood and is likely multifactorial. Proposed contributing factors include bacterial biofilm (a microscopic layer of bacteria on the implant surface), hematoma (blood collection near implant), seroma (fluid collection around implant), low-grade inflammation, implant rupture, radiation therapy, and individual differences in wound healing.
How Is Capsular Contracture Treated?
Treatment depends on the severity of symptoms. Mild capsular contracture may be managed with observation or, in selected patients, antibiotics with off-label medications such as leukotriene inhibitors (like montelukast (trade name Singulair).
Moderate to severe capsular contracture (Baker Grade III or IV) typically requires surgery. Revision procedures may include a capsulectomy (removing scar tissue), implant exchange, and/or changing the implant pocket. If a silicone implant rupture is suspected, imaging with a high-resolution ultrasound or MRI may also be recommended before surgery.
For recurrent or high-risk cases, your plastic surgeon may consider using an acellular dermal matrix (ADM) such as AlloDerm® or similar biologic or biosynthetic materials (like mesh) to provide additional implant support and potentially reduce the risk of future contracture in selected patients.
Can Capsular Contracture Recur?
Yes. Patients who have experienced one capsular contracture are at an increased risk of recurrence. Fortunately, meticulous surgical technique, implant exchange, careful pocket selection, minimizing bacterial contamination, and appropriate patient selection can significantly reduce this risk.
If you notice increasing breast firmness, pain, asymmetry, or a change in implant position, an evaluation by a board-certified plastic surgeon is recommended to determine the cause and discuss the most appropriate treatment options.
Meet Dr. Brian Bassiri-Tehrani
Dr. Brian Bassiri-Tehrani is a double board-certified plastic surgeon with extensive training and expertise in complex breast revision and body contouring in NYC. He will guide you through every step of the process to ensure your safety and to optimize your results. To make an appointment, call (212) 540-6868 or click here.
