Capsular Contracture Explained

A capsule is a medical term for the naturally occurring scar tissue which forms around a joint, muscle or foreign body. A foreign body describes an object which is inserted into the body which our bodies do not naturally create. This can be anything from knee replacements to breast implants to metal plates that treat broken bones.

The forming of a capsule is a normal part of the healing process after a breast augmentation procedure. Our immune system will always form a capsule around a breast implant, and the vast majority of the time, this capsule will comfortably hold the implant in place and cause no further issues.

Some problems can occur if this capsule tightens or contracts; this is known as capsular contracture. Capsular contracture can occur in one or both breasts. It happens to around 5% of patients with no specific identifiable cause or reason. It is one of the most common postoperative complications associated with breast enlargement surgery.

While capsular contracture does not pose an immediate danger to health, it can cause discomfort or lead to frustrations of having undesired results of a breast augmentation procedure or having misshapen breasts. Capsular contracture can sometimes lead to an implant rupture, for which consultation and treatment should be sought as soon as possible.

Symptoms of capsular contracture include a change in the shape of your breasts or stiffness around the treatment area. In more severe cases, capsular contracture can be very painful. You may experience some restricted movement or some degree of soreness when attempting to stretch or move your upper body. It can also be identified by a hardening of the implant or the area around the implants or identified if the breast or breasts reposition themselves on your chest. In some more severe cases, there may even be visible changes to the surface of the skin around the breast.

If you suspect you are showing signs of capsular contracture, you should schedule an appointment with your GP or a specialist. You can also schedule a free consultation with an expert surgeon. They may describe the diagnosis in a grade from one to four. This is known as the Baker Scale.

The Baker Scale

Grade I: Asymptomatic or no contracture at all

Grade II: Painless and mild contracture, almost undetectable

Grade III: Moderate contracture, some firmness is evident, and the patient experiences some discomfort

Grade IV: Severe contracture. The patient is likely in pain. It can be diagnosed through observation alone.

Usually, symptoms of capsular contracture will become evident within the first months of a breast augmentation procedure, but there is a small chance that capsular contracture can occur at any time after breast implants are put in.

As yet, there is no precise or singular cause of capsular contracture. However, studies have shown that there are some circumstances in which capsular contracture is statistically less likely to occur.

Your choice of implant can potentially lower the risk of capsular contracture. Some studies have concluded that textured implants are less likely to lead to capsular contracture than smooth implants. Some research also suggests that the placement of the implant below the muscles in the breasts (submuscular placement) will lead to a lower chance of capsule contracture compared to surgeries where the implant is placed under the skin (subglandular placement). The surgeon may also opt to use the Keller funnel method to minimise the possibility of capsular contracture occurring.

That said, capsular contracture remains an unfortunate risk in any breast augmentation procedure. In almost all cases, it is neither the fault of you, the patient, nor the fault of your surgeon.

The safest and best option for you as a patient is to choose an experienced BAAPS/BAPRAS surgeon and follow all of their pre-and postoperative instructions as close as you can. Some surgeons may suggest gentle postoperative implant massages. They may advise you to wear a postoperative bra or suggest certain exercises to loosen the treatment area. Every person’s body is unique, and so too is every recovery different. Your surgeon will know best which steps you should take to reduce any surgical complications.

Unfortunately, there are no guaranteed non-surgical methods to treat or eradicate capsular contracture altogether. Some patients have reported that ultrasound treatments can lead to signs of improvement. It is advised you speak with your GP or schedule a consultation with a specialist to discuss this matter. The most effective way to treat capsulate contracture is through revision, such as breast implant removal surgery or breast implant replacement surgery.