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 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.