Signs of Capsular Contracture After Breast Augmentation?

Thanks for the question, Olive.

Capsular contracture is something that I help my patients with frequently. One of the most common reasons for people with implants to have additional surgery is capsular contracture.

There are four grades of breast capsular contracture - The grading is as follows:


Grade I the breast is normally soft and looks natural

Grade II the breast is a little firm but looks normal

Grade III the breast is firm and looks abnormal

Grade IV the breast is hard, painful, and looks abnormal.


Some patients actually prefer the look of mild capsular contracture (grade 1-2).

Many theories have been proposed about the formation of capsular contracture but current literature indicates that it is likely an immunologic response.

The following techniques have been employed to fight capsular contracture:


submuscular breast implant placement - likely has a role in decreasing capsular contracture

using textured implants - many recent studies show this is not an effective in preventing capsular contracture

limiting handling of the implants and skin contact prior to insertion - follows the immunologic basis of capsular contracture indicating that less handing causes lower bacterial contamination and is likely an important concept in preventing capsular contracture

irrigation with triple-antibiotic solutions - as above although care about solution selection must be used as some solutions void the warranty of the breast implant.


In my practice I have found submuscular placement of breast implants, avoiding handling as much as possible of the implant and triple antibiotic irrigation of the implant and the pocket significantly reduces capsular contracture numbers.

A study in 1984 and in 1990 examined saline vs. silicone capsular contracture rates and actually found silicone to be higher but this was likely secondary to the fact that a RUPTURED silicone implant causes much more of an immune response and is likely to cause capsular contracture. It is not clear that there is a large difference between intact implants and also not clear if the newer silicone implants - if they were to rupture - would have the same problem.

Treatments for capsular contracture have included:


Closed capsulotomy (disrupting the capsule via external manipulation), a once common maneuver for treating hard capsules, has been discouraged as it can cause implant rupture, poor efficacy, reforming of the capsule and patient pain.

Nonsurgical methods of treating capsules include massage, external ultrasound, leukotriene pathway inhibitors (Accolate, Singulair)


However the most reliable and common way to treat capular contracture is to remove the capsule and replace the implant. This is a relatively short outpatient procedure that patients tolerate well. Sometimes we recommend delaying replacing the implant to lower the risk of capsule reformation in extreme cases.

I hope this helps!

Capsular contracture is a condition where scar tissue around a breast implant tightens, making the breasts feel firmer, appear misshapen, or become painful.
Diagnosis is through physical exam or imaging like ultrasound or MRI. It's graded by severity: Grade I (soft, natural appearance) to Grade IV (hard, painful, abnormal appearance).
Caused by bacterial biofilm, prevention includes "no-touch" surgical techniques, antibiotics, and pocket irrigation with antibiotic solutions.
Treatment options range from medication to surgical interventions like capsulectomy (scar tissue removal) or capsulotomy (scar tissue incision).
Regular surgeon follow-ups are crucial for monitoring and managing this condition.

Capsular contracture is a potential complication that can occur after breast augmentation surgery. Some signs and symptoms of capsular contracture may include:1. Breast firmness or hardness: The breast may feel unusually firm or hard to the touch.2. Breast pain: Some patients experience discomfort or pain in the affected breast.3. Breast distortion: The breast implant may become misshapen or appear to be higher on the chest than the other breast.4. Tightness: Patients may feel a sense of tightness in the breast.5. Changes in breast appearance: The breast may look different in shape, size, or position compared to the other breast.If you suspect you have capsular contracture, it’s essential to consult with your plastic surgeon. They can assess your condition and recommend appropriate treatment, which may involve surgical intervention to remove or replace the implant and correct the capsule.