Is There a Time Line for Capsular Contracture Progression?

My surgeon told me this week I have capsular contracture level 2. My breast is firm and painful when I sleep on my stomach or hit into anything. There is no change of shape it's just a little higher then the right. Would this actually be level 3? Is there a certain time period where you know if it will progress or not progress? Does sleeping on your stomach help or hurt capsular contracture? I have silicone under the muscle. Thank you

Doctor Answers 5

Capsular contracture

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Everyone progresses differently and some do not progress.  However, if the implant is high and painful it sounds like a three.  But this is all semantics. If it bothers you, you may want to consider revision surgery.

The only real question with capsular contracture is: "Does it bother you?"

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If you have pain, then it is at least a Class III capsular contracture.  And it might stay just like it is now, or get slowly worse.  But at any given time, you don't have to treat it unless the symptoms are bothering you enough.  If this is only bothering you a little bit, it might be best to leave it alone.

If you do have a revision, using Alloderm helps prevent recurrence.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Capsular contracture timeline

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Everyone is different. Some patients develop a capsule which remains constant and does not worsen whereas, for others, the capsule continues to harden, producing pain and disfigurement of the breast.   Sleeping on your stomach would have no effect on the internal capsule.  You have the option of watchful waiting or could undergo open capsulectomy.  You should discuss this with your plastic surgeon and then create a plan. 

Time line for capsular contracture

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There is no time line for capsular contracture, and some implants firm a bit though never get any worse. To compare surgeons have a grade 1 to 4 classification, and your description is about a 3 with an implant that is firm and visibly different (higher) than the other. With luck you could stay that way, or relax to a 2 without any visible difference in the breast.

Best of luck,

Progression of Breast Capsular Contracture

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The commonly used Baker Classification for breast implant capsular contracture is:

Baker I - soft breast without significant scar tissue (Normal)
Baker II - scar tissue around the implant felt by touch but not visible (Almost normal)
Baker III - visible and palpable hardening, leading to a deformed shape to the breast (Abnormal)
Baker IV - a hard breast that is very painful to even mild touch (Most severe)

So unless you have pain due to other causes, you may have a grade 4. Sleeping on your stomach will not make it worse. In most cases, surgery to remove the capsule is the best option.

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.