What Is Capsular Contracture? Understanding the Symptoms

After an implant is placed, fibrous scar tissue begins to develop around it, forming a tissue capsule. Usually, this capsule is soft or mildly firm, inconspicuous, and helps stabilize the implant. But in some cases, the scar tissue becomes abnormally tight and hard around the implant. This is known as capsular contracture.

“No two capsular contracture experiences are the same, which is why it’s worth discussing changes in firmness, shape, or your comfort with a specialist,” advises Tzvi Small, MD, FACS, a plastic and reconstructive surgeon at The Institute for Advanced Reconstruction.

Knowing the capsular contracture symptoms, grading scale, and treatment options can help you understand what those changes may mean.

Symptoms of Capsular Contracture

The onset of capsular contracture can range from weeks to years after implant surgery. Symptoms often start gradually and progress slowly. The main capsular contracture symptoms include:

• Asymmetry: One breast may become firmer, higher, or shaped differently than the other.
• Change in breast shape: The breast may appear distorted, rounded, or misshapen.
• Firmness and hardening: The affected breast may feel like an apple or a ball is under the skin.
• Implant displacement: Scar tissue can push the implant upward, making it sit too high on the chest.
• Less implant mobility: The implant may become more difficult to move because of the tight capsule.
• Pain: Tightness and pressure around the implant can cause discomfort and pain.
• Rippling or wrinkling: With more severe contracture, changes may become visible on the breast’s surface.

What Does Capsular Contracture Feel Like?

The early signs of capsular contracture can be easy to miss. One breast may feel firmer or tighter while still resembling the other. As the condition progresses, the affected breast may harden, change shape or position, and become painful.

If you notice unexpected changes in your breast, talk with your breast surgeon.

What Causes Capsular Contracture?

It isn’t always clear what causes capsular contracture. Several factors may contribute, including:

• Bacterial contamination or biofilm: Bacteria around the implant can cause inflammation.
• Genetics: Some people may be more prone to developing thick or excessive scar tissue.
• Hematoma or seroma: A buildup of blood or fluid after surgery may increase inflammation.
• Implant rupture or leakage: Implant material released into the surrounding tissue can trigger an inflammatory response.
• Radiation therapy: Radiation to the breast or chest can raise your capsular contracture risk.
  
  

It isn’t always possible to prevent capsular contracture. Once it develops, your surgeon will use the Baker grading scale to assess its severity.

Baker Grading Scale: How Severity Is Classified

Surgeons use four capsular contracture grades to classify severity:

• Grade I: The breast feels soft and looks natural. The capsule is present but isn’t causing symptoms.
• Grade II: The breast feels slightly firm but still looks normal.
• Grade III: The breast feels firm with visible changes. The implant may look distorted or sit too high.
• Grade IV: The breast is hard, painful, and visibly affected.
  
  

Is capsular contracture dangerous? It usually isn’t life-threatening, but higher-grade contracture can cause intense pain. You should always have new symptoms evaluated to rule out other implant-related complications.

Treatment Options for Capsular Contracture

Capsular contracture treatment depends on the level of your symptoms, the condition of your implant, and whether you’ve experienced contracture before.

Grade I or II cases are often monitored, especially when there is little discomfort. Your surgeon may talk with you about nonsurgical approaches such as medication, massage, or therapeutic ultrasound.

More advanced or worsening capsular contracture may require surgery. Options include:

• Capsulectomy: Removes part or all of the scar tissue capsule.
• Capsulotomy: Releases portions of the capsule to give the implant more room.
• Flap reconstruction: Reconstructs the breast with tissue from your abdomen or buttocks.
• Implant removal: Removes the implant without replacing it.
• Implant revision: Removes and replaces the implant, sometimes changing its size, type, or placement.
  
  

Capsular contracture can recur, so your surgeon will consider your procedure history, risk factors, and goals when recommending a treatment plan.

When Is Surgery Needed for Capsular Contracture?

A surgeon may consider capsular contracture surgery for Grade III or IV cases. It’s a strong treatment option if the breast is firm, visibly distorted, painful, or hasn’t improved with conservative treatment.

For complex or recurrent cases, a surgeon experienced in revision breast reconstruction can help determine the best approach.

Considering Revision Surgery for Capsular Contracture?

“Patients who have already been through breast surgery, sometimes more than once, deserve a thoughtful look at why capsular contracture is happening. We can help find a treatment that gives you the best chance at looking and feeling like yourself again,” says Dr. Small.

The fellowship-trained microsurgeons at The Institute for Advanced Reconstruction specialize in complex and revision breast reconstruction, including cases that other practices may not take on. Schedule a consultation to discuss your symptoms and treatment options.