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!

Baker Grading system for Capsular Contracture: Signs of capsular contracture:  Baker Grade 1. No Change.  Normal.  Baker Grade 2. Change in firmness. Baker Grade 3. Change in shape, often rising higher on the chest and rounding into a ball.  Baker Grade 4. Grade 3 plus pain. A Change in firmness and shape in 10 year old implants is suspicious for capsular contracture. Chances of capsular contracture at 10 years is 6-24%. Sometime this is a sign that the integrity of the implant is compromised. This is diagnosis can be made by an experienced plastic surgeon. Sometimes a mammogram and/or sonogram can confirm the diagnosis, but an MRI is the best test, if needed.  Implants are are not life time devices. Unless imaging could change the decision, it is often not needed. Treatment involves removal of the implant and the capsule, then replacement with new implants. Singulair given daily for 90 days after surgery, reduces the chance of recurrent capsular contracture by 70%.  

The term capsular contracture  refers to the scar that surrounds a breast implant.  In the course of normal healing all wounds whether they be traumatic or elective will heal by creating a scar.   Now when a scar heals around a circular objects such as a breast implant, it will continue to contract until it meets an equal or opposing force.  If this contracture is allowed to happen to its fullest extent it will make the implant feel hard as a rock.  So the goal after breast augmentation is to allow enough healing so that a breast incision doesn't fall apart, and at the same time not contract so much that it feels like a rock on a woman's chest.  We know that scar tissue will forms in response to an inflammatory insult.  Over the years we have identified a number of things  that may prolong this inflammatory response. These include powder from the gloves, excessive touching of the device, blood around the implant in the pocket, or infection.  So a lot of the techniques we do today are designed to reduce these inflammatory stimulants.  Also we have attempted to reduce capsular contractures with the intervention of textured implants, no touch technique, antibiotic rinsing of implants and the breast pocket.  In an effort to put some reference to how bad a capsular contracture is,a rating scale was created referent as the Baker scale.  The Baker scale rates firmness of an implant on a scale of 1-4.  A baker 1 capsule is what we will call normal healing and can barely be detected stair.   In a Baker 2 the breasts looks fine but when you feel them they if feels firmer than normal. In a Baker 3 capsule the implant is obviously contracted  and the tightness around the implant on the chest gives the breast a distorted look.  And finally a baker 4 contracture not only has all the characteristics of 3 but also can be quite uncomfortable.  For the most part based on a woman's history I can tell if an implant is ruptured. Between her describing how they felt previously to how they feels now, coupled with a good physical exam, most of theme one can tell if an implant has failed.  The typical story is my implants felt soft or supple or slightly firm and then a year or 2 ago started feeling harder and finally got to the point of where they were just uncomfortable. Good luck

Thank you for your question.  Capsular contracture occurs when scar tissue forms around the breast implant.  It is normal to form a small amount of scar tissue around the breast implant.  When someone forms too much scar tissue, a capsular contracture is the result.  There are different grades of capsular contracture.  The scar tissue can cause the breast to become hard, painful and irregularly shaped.  The scar tissue changes the shape of the implant.  A board certified plastic surgeon will be able to determine the grade of your capsule based on the appearance and shape of your breast and recommend the best treatment to correct the capsule.

Capsular contracture after breast augmentation occurs when the scar tissue that forms around the implant tightens, causing the breast to feel firmer or harder and sometimes resulting in changes in the breast's appearance.
Signs of capsular contracture can include:
-Change in size/shape of the implant (if the implant is higher or more spherical)
-Firmness or hardness
-Pain or discomfort
-Asymmetry
Capsular contracture is diagnosed through a physical examination by a plastic surgeon. Imaging studies like ultrasound or MRI may be used for further evaluation, especially in more advanced cases or if there is a concern about implant rupture. The condition is graded from I to IV, with higher grades (III and IV) often requiring surgical intervention to remove the thickened capsule and replace the implant.
If you notice changes in your implants after several years, it is recommended to see a qualified plastic surgeon for an evaluation and discuss possible treatment options.
As of 2020, the FDA currently recommends screening your breast implants with MRI or ultrasound beginning five to six years after silicone implant placement and every two to three years thereafter.
Krishna Vyas, MD, PhD, MHSHarvard, Hopkins, & Mayo Clinic Trained Aesthetic Plastic SurgeonNew York, New York

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.

Signs of capsular contracture include the breast feeling firmer or harder than usual, noticeable distortion or misshaping of the breast, discomfort or pain in the affected breast, and visible asymmetry compared to the other breast. When a breast implant is placed, the body naturally forms a protective lining around it, known as a capsule. Capsular contracture occurs when this capsule tightens or contracts around the implant, causing the breast to harden, become painful, and sometimes distort in shape. It's essential to monitor any changes post-surgery and consult with your plastic surgeon if you suspect capsular contracture for appropriate management and care.

Pain, appearance, and firmness are the three criteria plastic surgeons use to determine if a patient has a capsular contracture and the severity thereof. You describe firmness and a change in the external appearance of the breast which would categorize you as a Baker Classification Grade 3 capsular contracture out of a possible 4 grades. I typically recommend capsular contracture surgery at Grade 3 or 4.

Signs of capsular contracture include firm ad tight sensation, high-riding breasts, pain, and asymmetry. The diagnosis is most commonly based on examination alone by your doctor. Further tests like MRI can offer further help in making the definite diagnosis.

Excellent question! A capsule is a scar envelop that forms around the implant in most patients. It's not bothersome and not noticeable when the capsule is thin. When the capsule contracts, or shrinks, the implant may change position (raise higher in the chest), become harder, and even sometimes painful. Late stages of capsular contracture are defined by hardness and pain.

I would recommend an appointment with a plastic surgeon. More advanced capsular contracture can be diagnosed with physical exam. The most effective solution to treat capsular contracture is to perform surgery to remove the capsule and replace the implant. Hope that helps!

Capsular contraction can be diagnosed clinically in an examination but early stages need scans ti find out the extent of capsule formation. the formation is not time bound and can happen any time after breast augmentation. After 10 years it is a good practice for annual check up for your implants. If the breast implants feel harder, there is possible changes related to capsular contraction. Please see a Plastic Surgery Consultant for assessment and discuss plans for further management. If needed you might get an ultra sound or MRI scan if appropriate by your surgeon.