Capsular contracture is a complication that occurs after breast implant surgery. When an implant is placed, the body forms a layer of protective scar tissue, known as a capsule, around it. Capsular contracture happens when this capsule thickens, hardens, and contracts or tightens around the implant. This squeezing action leads to noticeable changes in the breast’s appearance and feel, ranging from minor firmness to significant distortion and discomfort. It is considered one of the most common complications associated with breast implants, with reported rates ranging between 5% and 15% in primary breast augmentation.
Identifying the Visual Changes
A visible change in the shape of the breast is a primary sign of capsular contracture. When the fibrous capsule tightens, it constricts the implant, often resulting in a breast that appears rounder, more globular, or unnaturally high on the chest wall. This upward displacement results from the contracting tissue pulling the implant out of its intended position.
The tightening can also cause the breast to lose its natural slope and projection, creating a less fluid contour. A change in symmetry between the two breasts is a common visual indicator, as the contracture frequently affects one side more severely than the other. The affected breast may look noticeably different in shape or size compared to the unaffected side.
In individuals with thinner skin or less overlying breast tissue, the pressure from the contracting capsule can make the implant’s surface irregularities visible. This visual sign is often described as rippling or wrinkling of the implant, which becomes noticeable on the skin’s surface.
The Tactile Sensation
A change in how the breast feels to the touch is a primary indicator of contracture. The most frequently reported sensation is an unnatural firmness or hardening of the breast tissue.
The affected breast may feel rigid, sometimes compared to the consistency of a hard rubber ball or an apple. This rigidity is due to the dense, tightly woven collagen fibers that make up the thickened capsule. As the scar tissue constricts the implant, a feeling of tightness may develop, as if the implant is being squeezed.
This tightness can lead to restricted movement of the implant within the breast pocket, reducing its normal mobility. Tenderness or discomfort can also accompany the firmness, stemming from the pressure the capsule exerts on the surrounding tissue.
Categorizing Severity The Baker Scale
The Baker Classification system is used to grade the severity of the visual and tactile signs of capsular contracture. This scale ranges from Grade I to Grade IV, providing a consistent metric for assessment. The classification synthesizes physical examination findings with patient feedback on firmness and appearance.
Baker Grade I describes a breast that is soft and appears completely natural, indicating a healthy, non-constricting capsule. Progression to Baker Grade II means the breast feels slightly firm to the touch, but its visible appearance remains normal. At this stage, the subtle firmness is often more noticeable to a clinician during an examination than to the patient.
A contracture is classified as Baker Grade III when the breast is firm and has begun to show visible signs of distortion or abnormality. This grade represents the point where the tightening capsule visibly alters the breast’s contour. The most advanced stage is Baker Grade IV, where the breast is hard, visibly misshapen, and often associated with pain; in these advanced grades, the capsule is often found to be thicker, sometimes measuring over two millimeters.
When Physical Changes Warrant Professional Review
Identifying any unexpected change in the feel or appearance of an augmented breast is a reason to seek medical consultation. Regular self-examination is recommended, as recognizing differences in firmness or contour can lead to earlier assessment. If a person notices new asymmetry, a change in the breast’s height, or a palpable ridge of hard tissue, they should schedule an appointment with their surgeon or physician.
A professional review involves a physical examination to assess the firmness and appearance of the breast, often using the Baker Classification as a guide. The physician may recommend diagnostic imaging, such as an ultrasound or magnetic resonance imaging (MRI). Ultrasound can measure the thickness of the capsule, which often correlates with the severity of the contracture, helping to accurately assess the condition of the implant and the surrounding fibrous tissue.