Signs of Capsular Contracture After Breast Augmentation?

my breast implants are now 10 years old and stick out more.  When older breast implants feel somewhat harder and seem to stick out more is it capsular contracture?  How does a doctor determine if a patient has this problem?

Doctor Answers 219

Capsular Contracture Answers

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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:

  1. submuscular breast implant placement - likely has a role in decreasing capsular contracture
  2. using textured implants - many recent studies show this is not an effective in preventing capsular contracture
  3. 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
  4. 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:

  1. 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.
  2. 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 What is it? Preventing capsular Contracture with Keller Funnel

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Any time a foreign object is implanted in the body, whether it is a pacemaker or a breast implant or an orthopedic device or anything else, the body responds by forming a thin, wispy, fibrous membrane around it. In most cases this membrane or 'capsule' stays thin and wispy, but in some cases over time the capsule may tighten around the implant and thicken, making the implant feel firm or even hard. In advanced stages the contracted capsule can even distort the shape and position of a breast implant. Capsular contracture can be treated, but it is a surgical treatment, so avoiding capsular contracture is all about avoiding another trip to the operating room.
Capsular contracture can occur on one or both sides, and while it can develop early (weeks) or late (years) after a breast augmentation surgery, in the vast majority of cases it is evident fairly early following the procedure. So the good news is that once you are six to 12 months out from your surgery, if your augmented breasts are soft and supple then they are likely to stay that way for the long term.
It is believed that capsular contracture is primarily a response to the presence of low-virulence or non-virulent bacteria (i.e. not the kind that generally produce an actual infection, with redness/tenderness/fever etc) that adhere to the implant surface on the day of surgery, and which over weeks and months following surgery stimulate the cells that make collagen (called fibroblasts) to make more collagen - thickening the capsule and stimulating it to contract and tighten around the implant. It is not an actual infection; there are no symptoms that this is going on, and taking antibiotics will not prevent the process or reverse it. The source of these non-virulent bacteria is thought to be the patient's skin, or the ductal systems of the breast that lead to the nipple, as both are normally colonized with bacteria.
Because plastic surgeons now have an understanding of some of the reasons why capsular contracture occurs, there are a number of measures that can be taken to significantly reduce the likelihood that it will happen following breast augmentation surgery. One of the many precautions I take is using the Keller Funnel. 

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 123 reviews

Signs of Capsular Contracture After Breast Augmentation?

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Increased firmness 10 years after breast implant surgery is certainly a capsular contracture. The implants themselves do not get firm. Capsular contracture is when the tissue surrounding the implant gets more dense and tightens arounds the implant squeezing it. If it tightens enough, the implant will get very firm and become shaped like a ball. Remember that the smallest space an object can occupy is a perfect sphere, and if the scar tightens enough, the implant will become a sphere. And, further tightening can even become painful. The grades of encapsulation are as follows: Grade 1- soft and normal, Grade 2- firm but normal in appearance, Grade 3- firm and becoming round like a ball, Grade 4- add painful to very distorted Grade 3.

If you are a Grade 2, I would do nothing. Grade 3, but only mildly distorted and you may need replacement of the implant and removal of the surrounding scar capsule(called a capsulectomy). Capsule contracture is the most common complication of an augmentation mammoplasty.  I would suggest consulting the plastic surgeon that performed the surgery or another board certified plastic surgeon for an opinion.

Some patients have had some softening of the encapsulation using the medication Singular, which is an anti-leucotriene. Add an anti-prostaglandin to that, such as Aleve, and you may have some relief. We have used a natural Vitamin E complex with some relief through the years as well. Good luck.

Anytime a foreign material is placed into the body, a rim of scar tissue is created to wall it off from the rest of the body.

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Anytime a foreign material is placed into the body, a rim of scar tissue is created to wall it off from the rest of the body, which is known as a capsule.This scar tissue is made up of myofibroblasts, which are found in muscle fibers.Over time, these myofibroblasts may begin to contract over the implant and create what is known as a capsular contracture.The main sign of capsular contracture is increasing firmness of the affected breast.This can lead to upward displacement of the breast implant, altered size and shape of the affected breast and pain.The technical definition of capsular contracture are as follows:Grade I — the breast is normally soft and appears natural in size and shape.Grade II — the breast is a little firm, but appears normal.Grade III — the breast is firm and appears abnormal.Grade IV — the breast is hard, painful to the touch and appears abnormal.

Gary Motykie, MD
Los Angeles Plastic Surgeon
4.3 out of 5 stars 68 reviews

Signs of Capsular Contracture

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Capsular contracture (CC) is a much less common occurrence than it used to be due to better implants, sub-muscular positioning of the implants, meticulous aseptic technique and better understanding of the cause of CC. When it does occur, there is a range of signs and symptoms. At the worst, the breasts can become hard and tender with the implant become distorted into a round and superiorly displaced position. If this occurs, it is generally the result of a mild subclinical infection which caused the body to "recognize" the implant and wall it off, or possibly from a leak, in the case of a silicone implant. Regardless of the cause, you should consult with your plastic surgeon as re-operation may be necessary.


Scott A. Brenman, M.D., F.A.C.S.
Plastic & Reconstructive Surgery

Scott A. Brenman, MD, FACS
Philadelphia Plastic Surgeon
4.6 out of 5 stars 53 reviews

Capsular contracture in breast augmentation

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One of the great controversies in breast augmentation surgery is the cause and treatment of capsular contracture. Capsular contracture is caused by the inflammation around the implant. When this inflammation is appropriate and not overdone, the implant stays soft but still protected from the rest of the body. For reasons that are not well understood, however, some people have an excessively robust response to the implant or something on it and the scar can become quite thick, tight, painful and visible. When this happens, there are both non-surgical and surgical solutions that can be attempted.  An exam helps determine whether an excessively tight capsule is present but in general an implant that is higher, firmer, rounder and no longer directly situated above the breast is likely the product of a capsular contracture.
Dr. Pyle

Jeremy Pyle, MD
Raleigh-Durham Plastic Surgeon
4.9 out of 5 stars 126 reviews

Breast implants do NOT get hard, ever. But the scar capsule around them can contract and make your breast(s) firm or distorted.

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Breast implants do not "wear out" at around ten years or so. This is urban legend. Saline implants can leak or deflate (textured implants more frequently), requiring replacement via surgery. Older types of silicone implants can rupture, and the gel inside does not absorb, but can cause the scar capsule to thicken and the breast to feel firm, lumpy, or irregular. Replacement (including removal of the capsule) is necessary.

In your case, since your implants were placed around 2000, you most likely have saline implants. If one implant had a leak, that breast would be soft(er) than the other, and smaller. But you describe both as harder and sticking out more. This is capsular contracture, and the severity is something that you and your plastic surgeon can determine. You can decide if it is worsening. Both of these factors are part of deciding if and what kind of surgery is necessary. Consultation with your plastic surgeon, or another well-trained, experienced, board-certified plastic surgeon is next. Even if you have silicone implants, your capsular contracture may need to be addressed, and this requires an examination with your plastic surgeon. Rest assured that this can be improved or corrected! Best wishes, Dr. Tholen

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
4.9 out of 5 stars 263 reviews

Signs of Capsular Contracture after Breast Augmentation?

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Most likely with 10 year old implants the firmness you are feeling is from capsular contracture. Capsular contracture is scar tissue that forms around the breast implant. All women have scar tissue around their breast implants but when the scar tissue becomes too thick it becomes firm and can become a problem. A doctor can determine if a patient has capsular contracture by experience and examination.

Robert Heck, MD, FACS
Columbus Plastic Surgeon
4.9 out of 5 stars 83 reviews

Capsular Contracture after Breast Augmentation makes the breast feel hard

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Thank you for your question. The diagnosis of Capsular Contracture after Breast Augmentation with implants is made by physical exam. If the Breast Implant looks smaller, rides higher on the chest than before and feels hard and does not move freely then most likely the diagnosis would be Capsular Contracture.

See your doctor for an examination

Capsular Contractures in Breast Implants

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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.

Max Polo, MD
Miami Plastic Surgeon
4.9 out of 5 stars 41 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.