Capsular Contracture

Whenever an implant is placed in the body, the body responds by forming a thin layer of scar tissue around it, called a capsule. This is normal and usually harmless — in fact a soft capsule helps hold the implant in place. In capsular contracture, however, this capsule thickens and tightens, squeezing the implant. The result can be firmness, a change in shape, a higher-riding or distorted breast, and sometimes discomfort or pain. Capsular contracture is one of the most common reasons patients need revision surgery, so understanding it is well worth your time.

How capsular contracture is graded

Surgeons describe the severity using the four-point Baker grading scale:

• Baker Grade I: the breast is soft and looks natural — a normal capsule.
• Baker Grade II: the breast is slightly firm but still looks normal.
• Baker Grade III: the breast is firm and looks abnormal — for example distorted or too round.
• Baker Grade IV: the breast is hard, distorted and often painful.

Grades I and II generally need no treatment. Grades III and IV are considered significant and are the ones that often prompt surgery.

Why does it happen?

The exact cause is not fully understood, and it is probably multi-factorial. The leading theory links capsular contracture to a low-grade bacterial film (biofilm) on the implant surface, which triggers a stronger scar response. Other factors that have been associated with higher rates include bleeding or haematoma around the implant, infection, certain implant surfaces and, in some studies, subglandular (over-the-muscle) placement compared with sub-muscular. It can occur early or develop years later, and it can affect one or both breasts.

How it is prevented

While no approach eliminates the risk, surgical technique can reduce it:

• Meticulous, sterile no-touch technique and pocket irrigation.
• Careful control of bleeding to avoid haematoma.
• Appropriate implant and placement choices for your anatomy.
• Some surgeons recommend specific implant massage protocols for smooth implants — though evidence is mixed and this is not advised for textured or anatomical implants.

How it is treated

Treatment depends on the grade and your symptoms. Mild cases (Grade I–II) are usually just monitored. For significant contracture (Grade III–IV), surgery is the mainstay:

• Capsulectomy — removing the thickened capsule.
• Capsulotomy — releasing or scoring the capsule to open up the pocket.
• Implant exchange — often combined with capsule surgery, sometimes with a change of implant type or plane (for example moving to a sub-muscular position), and sometimes using support materials.

Importantly, capsular contracture can recur after treatment, which is why getting the first operation right — and choosing an experienced surgeon — matters so much.

When to seek review

See your surgeon if a breast becomes firmer, changes shape, rides higher, or becomes uncomfortable or painful — whether weeks or years after surgery. Early assessment gives the most options. Remember that new, late one-sided swelling (as opposed to firmness) should also be checked, as it can rarely indicate BIA-ALCL.

Frequently asked questions