Capsular Contracture

Capsular contracture is also known as capsule contracture and breast implant hardening. It is the most feared breast augmentation complication because it is the most common. Capsular contracture usually arises within six months to a year after surgery, but it can occur at any time after surgery, including years down the road.

What Does Capsular Contracture Look Like?

Capsular Contracture Photo

The photo below depicts capsular contracture. As you can see, the subject’s breasts appear misshapen, very round, and hard. However, capsular contracture can present in other ways as well. The implant won’t always look perfectly round or ball-shaped. The breast implant may ride up on the chest towards the collarbone, often giving the breast an oblong or rectangular shape.

Photo courtesy of Dr. Don Revis. If you would like to see the entire collage of this subject’s before and after photos, click here.

What is Capsular Contracture?

The body’s way of walling off foreign objects is to form a barrier around it. In the case of breast implants, a capsule of tissue, often called “scar tissue” (although it really isn’t “scar” tissue), is formed around the breast implant. The capsule is composed of collagen for the most part. This is normal, as the body is working in the exact way it is intended to. When that capsule begins to contract (shrink) around the implant, it compresses the implant, thus making it feel very hard. It is important to note that the breast implant itself has not hardened. The shrinking space the implant is in, which is the capsule, causes a great deal of pressure on the implant, making it appear to be hard. The video below shows an implant removed while still inside the capsule. As the surgeon cuts away the capsule, the implant is “released” and returns to its normal shape. (You can fast forward until 1:10 into the video.)

What Causes Capsular Contracture

The main cause for capsular contracture is thought to be subclinical infection inside the pocket. A subclinical infection is an infection that is without symptoms. Bacteria, even very minute amounts, can cause an inflammatory reaction inside the pocket. This can result in capsular contracture. An infection (not the subclinical type) can leave you at more risk for capsular contracture, as can a hematoma.

Most surgeons irrigate the pocket with an antibiotic solution, and many bathe the breast implants, which come pre-packaged in sterile packages, in antibiotoc solution prior to inserting them. These are just extra steps to help ensure that no bacteria is introduced in the pocket.

Women with breast implants placed over the muscle have a higher probability of getting capsular contracture then women with breast implants placed under the muscle. Many surgeons feel that it is because the implant is in contact with the breast tissue, which can trigger more scarring.

If the breast implants are inserted through the areola, they will come into contact with the milk ducts, which naturally harbor bacteria. The only way to avoid this is to use inflatable saline breast implants, and insert them through a sleeve, which protects the implant from coming into contact with the milk ducts upon insertion. Unfortunately, prefilled silicone gel breast implants cannot utilize the sleeve, and therefore will come into contact with the milk ducts when inserted via the areola.

Breast implant placement seems to play a role as well, as breast implants placed under the muscle have a lower risk of capsular contracture than their over the muscle counterparts.

Some surgeons believe that smoking can increase the risk of capsular contracture, as it constricts blood vessels, and is not conducive ti healing.

Symptoms of Capsular Contracture

After surgery, many women immediately begin to become paranoid about getting capsular contracture. In the early days of recovery, you may worry that you have capsular contracture because of the fact that one breast implant isn’t shaped exactly like the other, or because one breast implant is higher than the other, or because one implant is firmer than the other. It is important to remember that during the early days of recovery, this is perfectly normal. If you are taking weekly photos of your breasts to document your changes, you will know if things are changing for the better or for the worse.

The first signs of capsular contracture are very subtle, as this complication doesn’t appear over night. Instead, it slowly progresses. If your implant(s) does not get softer, but instead gets firmer, or if your implant(s) stops dropping, or settling into the pocket, and instead moves upward on the chest, you may have capsular contracture.

Grades of Capsular Contracture

There are four grades of capsular contracture:

Grade I:
The breast implant feels soft and the breast appears natural.
Grade II:
The breast implant feels somewhat firm, but no physical distortion of the implant has occurred.
Grade III:
The breast implant feels notably firm, and the breast has taken on an unnatural shape. The breast implant may appear very round (ball-like), or it may be high up on the chest wall (failure to drop due to capsular contracture), or have anything other than a natural shape.
Grade IV:
This is the worst grade. The breast implant feels exceptionally hard, and is very obviously distorted in shape.