Capsular Contracture

What is capsular contracture?

After breast augmentation, the natural response of the body is to form an envelope of scar tissue around the implant, termed a ‘capsule’. If the capsule remains soft and thin, the implant remains soft and the breast retains its shape. However, in some patients the capsule thickens and contracts around the implant, which may cause progressive hardening of the implant, pain and breast distortion. This is called ‘capsular contracture’

Studies have shown this occurs in about 10-15% of patients but only 1 in 10 of those patients require surgery to treat it. Diagnosis of capsular contracture is made mostly by clinical examination to assess the firmness of the implant and to look for distortion and rippling. Ultrasound scans are helpful to confirm visual evidence of a thickened capsule and implant folding inside the capsule.

At Breast Implant Solutions we can carry out a high-definition implant ultrasound scan to look for evidence of folds within the implants suggesting that the capsule has tightened around the implant because of capsular contracture. This can help explain why the breast has become firmer.

What else can cause hardening of the implant?

Other causes of implant hardening include seroma (fluid accumulation) or haematoma (previous bleeding) inside the capsule. This is typically associated with swelling of the breast and can be either spontaneous or following trauma. The easiest way to distinguish between capsular contracture and seroma formation is by ultrasound scan. At Breast Implant Solutions, we can carry out a comprehensive assessment in a single visit to our clinic. This will involve a thorough implant history, examination with a chaperone and a high-definition implant scan, as well as the opportunity to ask questions to our consultant plastic surgeon performing the scan.

What causes capsular contracture?

The exact cause of capsular contracture is not fully understood, but it is believed to be a multifactorial condition with several potential contributing factors. The most common cause of capsular contracture is thought to be related to the body’s natural response to a foreign object, such as a breast implant. When a breast implant is placed in the body, the immune system recognises it as a foreign material and responds by forming a soft scar tissue capsule around the implant. This scar tissue capsule is a normal part of the body’s healing process after surgery, and is subtle and not able to be felt to touch.

However, in some individuals, the scar tissue capsule may undergo abnormal or excessive tightening and contracting, leading to capsular contracture. Several factors may contribute to the development of capsular contracture, including:

  1. Bacterial contamination: Infections around the implant or biofilm formation (a thin layer of microorganisms) may trigger an inflammatory response, leading to more aggressive scar tissue formation.
  2. Bleeding or hematoma: Blood accumulation around the implant during or after surgery may lead to an increased inflammatory response, potentially contributing to capsular contracture.
  3. Implant characteristics: Certain implant factors, such as surface texture (smooth implants have been associated with a higher risk), implant size, and implant fill material, may influence the likelihood of developing capsular contracture.
  4. Genetics: Individual genetic factors may play a role in determining a person’s propensity to develop an exaggerated immune response and scar tissue formation.
  5. Radiation therapy: Radiation therapy to the chest area, either before or after breast implant surgery, can increase the risk of capsular contracture.
  6. Trauma or injury: Physical trauma to the breast, such as a direct blow or injury, may trigger an inflammatory response that contributes to capsular contracture.

Prevention techniques, such as proper surgical techniques, post-operative care, and selecting appropriate implants, are important to minimise the risk of capsular contracture. If you are considering breast implant surgery or have concerns about existing implants, Breast Implant Solutions will help guide your decision making so you are well informed with the best international data from our team of experts.

How common is capsular contracture?

The chance of capsular contracture occurring increases over time. Many variables exist to increase or decrease the individual risk of capsular contracture. A scientific article recently critiqued all the key papers published on capsular contracture, and concluded that it affects 9% to 28% of patients by 10 years after surgery.

El-Haddad R, Lafarge-Claoue B, Garabedian C, Staub S (2018). A 10-Year Prospective Study of Implant-Based Breast Augmentation and Reconstruction. Eplasty. 18: e7.

What are the signs of capsular contracture?

Capsular contracture is a complication that can occur after breast implant surgery. It involves the formation of excessive scar tissue around the breast implant, leading to the tightening and contracting of the capsule. The severity of capsular contracture can vary, and not all individuals with breast implants will experience this condition. Signs and symptoms of capsular contracture may include:

  1. Breast firmness: One of the early signs of capsular contracture is increased firmness in the breast. The breast may feel harder and less natural to the touch compared to the other breast.
  2. Breast pain or discomfort: Some individuals with capsular contracture may experience pain, discomfort, or a feeling of pressure in the breast.
  3. Changes in breast shape: As the scar tissue contracts, it can cause the breast to change in shape, becoming rounder, higher, or distorted in appearance.
  4. Breast asymmetry: Capsular contracture can lead to asymmetry between the two breasts, with one breast appearing firmer or differently shaped compared to the other.
  5. Visible rippling or wrinkling of the skin: In some cases, capsular contracture may cause visible ripples or wrinkling of the overlying skin.
  6. Implant displacement: As the capsule tightens around the implant, it can push the implant upwards, leading to a higher position on the chest.
  7. Reduced breast movement: Capsular contracture can limit the natural movement of the breast, making it feel more fixed and less mobile.

It is important to remember that not all breast firmness or changes after breast augmentation indicate capsular contracture. Some breast firmness and mild asymmetry can be normal and expected during the healing process.

If you suspect you may have capsular contracture or are experiencing concerning symptoms after breast implant surgery, we recommend you discuss this with your plastic surgeon. If you would like a breast implant scan for reassurance and peace of mind, then we can arrange this for you at Breast Implant Solutions, and because the scan is performed by a consultant plastic surgeon, we can give you specific information about what the scan means for potential future surgery.

How serious is capsular contracture?

Capsular contracture can range in severity from mild to severe, and its impact on an individual can vary. In some cases, capsular contracture may not cause significant symptoms or aesthetic concerns and may not require immediate intervention. However, in more severe cases, capsular contracture can be uncomfortable, cause pain, and lead to changes in breast shape and appearance that can be troubling to patients who may want something done.

The severity of capsular contracture is often categorised using the Baker grading system, which helps classify the condition based on its clinical presentation:

  1. Grade I: The breast appears and feels soft and natural.
  2. Grade II: The breast feels slightly firm, but it still looks natural.
  3. Grade III: The breast feels firm, and there may be visible distortion in breast shape.
  4. Grade IV: The breast is hard, painful, and significantly distorted. Severe capsular contracture may cause discomfort and affect the implant’s position.

While capsular contracture itself is not life-threatening, severe cases can lead to significant discomfort and dissatisfaction with the appearance of the breasts. It can also impact the quality of life and emotional well-being of individuals who experience it.

In some instances, capsular contracture may require treatment or revision surgery to address the symptoms and improve the appearance and feel of the breasts. However, the decision to undergo surgery should be carefully discussed with your plastic surgeon, taking into consideration your general health, goals, and expectations.

Prevention of capsular contracture is our primary objective in breast implant surgery. Techniques such as placing the implant under the muscle, using textured implants, and maintaining proper post-operative care can help reduce the risk of developing severe capsular contracture. However, many patients we see have had surgery elsewhere, and therefore different preventative strategies may or may not have been practiced.

If you suspect you may have capsular contracture or are experiencing symptoms after breast implant surgery, you should discuss this with your surgeon. If you would like an implant scan to confirm capsular contracture please book here.

Can you get rid of capsular contracture?

Capsular contracture is a common complication that can occur after breast implant surgery. It happens when the scar tissue (capsule) that naturally forms around the breast implant tightens and contracts, leading to firmness, pain, and sometimes distortion of the breast shape. While it may not be possible to completely “get rid of” capsular contracture once it has developed, there are several treatment options available to manage its severity and improve symptoms.

Treatment options for capsular contracture may include:

  1. Observation: In some cases, mild capsular contracture may not cause significant symptoms or aesthetic concerns, and the condition can be monitored without immediate intervention.
  2. Massage and compression: Gentle breast massage and compression exercises, as advised by your surgeon, may help soften the scar tissue and improve breast shape.
  3. Medications: Some studies have explored the use of specific medications, such as leukotriene inhibitors, to potentially reduce inflammation and prevent the progression of capsular contracture. However, results have been mixed, and this is not currently a recognised treatment in the UK.
  4. Surgical revision: If capsular contracture is severe or causing significant discomfort or distortion, surgical intervention may be necessary. Revision surgery involves removing the existing scar tissue (capsulectomy) and replacing or repositioning the breast implants.
  5. Change in implant placement or type: In some cases, changing the implant placement (e.g., from over the muscle to under the muscle) or the type of implant used may reduce the risk of capsular contracture.

It is important to discuss your concerns and symptoms with an experienced plastic surgeon.
They can evaluate your individual situation and recommend the most appropriate treatment tailored to your needs. Remember that the management of capsular contracture can be complex and may require a customised plan based on the specific circumstances of each patient, therefore thorough patient assessment, clinical examination, and clinical imaging through ultrasound scans provides comprehensive information to make a well-informed decision.

Is capsular contracture dangerous?

Capsular contracture is not dangerous. It does cause hardening of the implant and pain in the breast but it is not dangerous and will not harm your health. It does not therefore have to be treated but many patients choose to treat it because the breast becomes uncomfortable to live with and in some cases the appearance of the breast is very unsatisfactory, so patients often seek corrective surgery.

What is the treatment of capsular contracture?

For patients with mild capsular contracture – Grade 1 and 2 – often no treatment is required and the patients live quite comfortably with their implants. For Grade 3, which includes distortion of the breast shape, and Grade 4, which includes pain, many patients seek treatment to correct the problem.

There are some non-surgical treatments that have been proposed but none that have yet had a recognised benefit in improving capsular contracture. The mainstay of treatment therefore is further surgery. This usually involves removing part or all, of the implant capsule on the affected side and placing a new implant. In most cases this solves the problem but a small group of patients who have an ongoing tendency towards capsular contracture may develop recurrent capsular contracture with the new implant.

How do you make a diagnosis of capsular contracture?

Capsular contracture is diagnosed mostly on a history of the symptoms from the patient and clinical examination. Usually, the patient describes hardening of one breast compared with the other side, sometimes with an elevation of the position of the implant, and in more severe cases this can include distortion of the breast and pain. Clinical examination by a plastic surgeon can assess the softness of one implant compared with the opposite side, and for confirmation at Breast Implant Solutions we will carry out an ultrasound scan to assess the implant capsules. In capsular contracture, we typically see folds in the implant caused by the tightening of the scar capsule around it on our high-definition ultrasound scan. This allows us to confirm the diagnosis of capsular contracture. We are able to show these images in real time to the patient being scanned, so there is an instant result.

At Breast Implant Solutions, when assessing a patient for capsular contracture, we take a thorough implant history, followed by a careful examination of the breasts with a chaperone, and then the assessment is completed with a high-definition breast implant scan to assess the state of the implant and the implant capsule. This combined approach provides a very accurate assessment of your capsular contracture status and will help us guide you going forwards. All the information is provided to you in a one clinic visit, and indeed we can show you the ultrasound scan images so you can see the changes in your breast implants.