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!

Hi, thank you for your question. 
Capsular contracture is a natural "foreign body reaction" of the breast to the implant. All surgical implants go through some degree of encapsulation/scar formation. You are right to recognize the change in shape, position and projection of your implants with the passing of time, however, many "old" implants never reach a point where there is any significant contracture. A significant contracture occurs when this scar around the implant becomes so excessive that it can cause painful distortion or displacement of the implant. Typically, a surgeon will consider treatment when the condition becomes symptomatic for the patient or aesthetically unappealing. 
The best way to determine the course of action is during an in-person visit with your board-certified plastic surgeon for a thorough examination. 
Options include surgical and non-surgical treatment. The choice is dependent on the clinical situation and your preference. 
I hope you have a quick resolution to your concern!

Hard implants at 10 years are likely to be capsular contractures, especially if there has been a change in the feel of the breast.  If the implant does not move, or is firm, it is the scar around the device (capsule), not the implant itself that is hard.

Capsular Contracture
typically presents as a hardening of the breast. This happens because the
body forms scar tissue around the implant and the scar tissue becomes overly
tight and thick. This squeezes the implant and cause the
breast to feel firm and hard. In severe
cases the patient can have pain in the breast.
The capsule can also deform the breast by changing the shape and
location of the implant.

Fortunately it is rare
that the capsule becomes so think and hard that it causes an issue for
patients. When capsular contracture does
occur it can be treated. Typically it is
treated by removal of the scar tissue and placement of a new implant. This will soften the breast and improve the overall
shape of the breast.

This is one of the many
reasons it is important to have you surgery performed by a board certified
plastic surgeon. There are many
techniques that plastic surgeons use to try and prevent capsular contracture
from ever happening.

It sounds like you have developed capsular contractures. Breast implants do not intrinsically change shape with time. Capsular contracture, when severe enough, can be an extrinsic force that will change the shape of a breast implant. The changes that you are describing are typical of a severe (grade 3 or 4) capsular contracture. The breast becomes more firm or even hard and the shape of the implant is distorted from a dome shape to a more spherical shape. The implant width or diameter may be reduced and the outward projection may be increased. Capsular contracture is diagnosed by history and physical exam. Breast imaging studies may demonstrate thickening and/or calcification of the capsular tissue or distortion of the implant, but these findings are not necessary to confirm the diagnosis.

Simple answer is "yes". There is normal scar tissue around an implant whether it is above or below the muscle. This is called a capsule...when the capsule tightens for a variety of reasons (trauma, low grade infection...), it is called "capsular contracture." This makes the implant feel harder. It's like squeezing a balloon. There are different grades of contracture. 
Bottom line, the implant should feel soft, move within the pocket, look natural ("not hard and stick out")
Surgery is indicated if the patient doesn't respond to non-invasive methods: Vitamin E orally 1000-2000 IU/day or Singulair.
If surgery, capsulectomy should be done (removing all the capsule)...not just a capsulotomy (opening the pocket/scar like an oreo cookie) Ask you surgeon about each. 
After surgery, restart the Vitamin E, Singulair, and massage to keep the pocket open...and breast sogt!
Good luck! 

A capsular contracture is something that usually occurs gradually over time, but is occasionally seen early in the post-op period. It is too much scar tissue forming around the implant. Everyone forms at least a thin scar, or capsule, around the implant that is not visible or palpable. That is a normal response to the procedure. However, if the scar tissue continues to progress, it can make the breast feel firm. In extreme cases, it can change the shape of the breast and even cause pain.To prevent this, I use a very strict sterile technique and place the implants behind the muscle. I also limit the handling of the implant and never let the implant touch the skin. Additionally, I irrigate the implant pocket with three different antibiotics as well as betadine prior to placing the implant into position. Studies have shown that this will limit your capsule rate to approximately one percent. If you have a capsule, surgery can be performed to remove it along with an implant exchange. Good luck!

When an implant is placed the body forms a layer of tissue around the implant, referred to as the capsule.  Capsular contracture is diagnoses on physical exam.  It is graded from I to IV based on the look, feel of the breast and any pain.Grade I: The breast is soft and looks natural.Grade II: The breast is slightly firm, but looks normal.Grade III: The breast is firm and looks abnormal.Grade IV: The breast is hard, painful and looks abnormal.

Capsular contracture refers to the hardening of the breast implant capsule which can cause a variety of functional and aesthetic consequence. In general, it can either be palpable, visible, and painful. Depending on clinical severity and patient preferences, surgery may be required to rectify the situation. There is a cumulative risk as well, i.e. the longer you have the implants, the higher risk you have in developing the condition. So it'll be best to consult your surgeon for further advice if this is a concern to you.

Hope that helps.

Best wishes

Ellis Choy

Hard breasts are very often due to a capsular contracture
particularly if they had been soft in the past and became harder over time.
Other possibilities for firmer feeling breasts can be weight loss where an
implant is more noticeable because there is less soft tissue padding on top of
it. Usually an experienced surgeon should be able to determine whether there is
a capsular contracture present based on a physical examination. If the implant
moves around easily it is less likely to be a capsular contracture whereas if
the implant is more fixed in place this is more consistent with capsular
contracture although a wide range of presentation is certainly possible.
Ultimately if the breasts are feeling hard or distorted and the implants are 10
years old it would not be a bad idea to see a Board Certified Plastic Surgeon
to have an evaluation and possibly replace the implants and remove some of the
old scar tissue.

capsular contracture after breast surgery is quite rare. The best ways to prevent this complication is bloodless surgery, use of antibiotics and massage and support after surgery. Signs of a harder capsule can be remove and the implant is replaced to the submuscular pocket.