Capsular contracture is the most frequent long-term complication associated with breast implants. The condition involves the formation of a firm, restrictive layer of scar tissue around the implant, which is a normal foreign body response that has become exaggerated and tightened. Although the body always forms a fibrous capsule around any implanted device, contracture occurs when this protective tissue constricts and hardens, causing noticeable changes to the breast. This tightening process can begin anywhere from a few months to many years following the original surgery.
Identifying the Visible Signs and Physical Symptoms
Capsular contracture involves both visual observation and tactile sensation. A breast affected by this condition often feels abnormally firm or hard, a texture sometimes described as feeling like a ball beneath the skin. This increased firmness distinguishes it from the natural softness of the implant and surrounding tissue, and is one of the earliest physical signs that an issue may be developing.
Visually, the tightening of the capsule can lead to a distortion of the breast’s shape. The breast may appear unnaturally round, globular, or misshapen due to the pressure exerted by the constricting tissue. The implant may be pulled upward and sit higher on the chest than intended, a displacement caused by the scar tissue shortening. Severe contracture can also cause the skin to show visible rippling or wrinkling.
Beyond changes in look and feel, capsular contracture can also cause physical discomfort or chronic pain. This sensation can range from a persistent tightness or pressure to ongoing tenderness in the breast area. The movement of the implant within the breast pocket may also become noticeably restricted, contributing to a feeling that the implant is “stuck.” This combination of altered appearance, increased firmness, and potential pain represents the clinical manifestation of the condition.
The Baker Grading System for Severity
Plastic surgeons use a standardized scale known as the Baker Grading System to classify the severity of capsular contracture, which helps guide treatment decisions. This system relies on both the physical examination of the breast and the patient’s report of symptoms. The scale is divided into four grades, ranging from a normal outcome to the most severe presentation.
Grade I is considered a normal outcome, where the breast remains soft and looks natural, making the implant non-palpable. Grade II represents a minimal contracture; the breast is slightly firm to the touch but still maintains a normal appearance. At this stage, the firmness is typically noticeable only upon physical palpation.
The condition becomes more apparent at Grade III, where the breast is firm and shows a visible abnormality or distortion in shape. Although the firmness is easily felt, pain is not always present at this level. Grade IV is the most advanced stage, characterized by a breast that is hard, painful, and visibly distorted in shape.
Why the Contracture Develops
Capsular contracture is fundamentally an exaggerated response by the body’s immune system to the breast implant. The body’s initial reaction is to form a thin, protective layer of fibrous tissue, called a capsule, around the implant. The contracture occurs when specific cells within this capsule, called myofibroblasts, become overactive and exert a constricting force.
This tightening transforms the normally soft capsule into a dense, fibrotic layer that squeezes the implant. While the exact cause is not completely understood, sustained inflammation is believed to be the primary driver. One significant theory points to subclinical bacterial contamination, or biofilm, a thin layer of bacteria that can form on the implant’s surface.
This low-grade bacterial presence can trigger a chronic inflammatory response that leads to the excessive production and tightening of the scar tissue. Other factors that may contribute include the development of a hematoma (a collection of blood) or a seroma (a collection of fluid) around the implant post-operatively. The body’s reaction to the implant material also plays a role in the formation of the fibrotic tissue.
Next Steps After Self-Identification
If you notice any visual or physical symptoms associated with capsular contracture, schedule an appointment with your plastic surgeon or a specialist. Self-diagnosis is not sufficient; a professional evaluation is necessary to confirm the condition and determine its severity using the Baker Grading System. The surgeon will perform a physical examination and may use imaging, such as an ultrasound, to assess the thickness of the capsule and the condition of the implant.
Management strategies are tailored to the contracture’s severity. For milder cases (Baker Grades I and II), the surgeon may recommend non-surgical approaches, including specialized massage techniques or the off-label use of medications, such as leukotriene inhibitors, which reduce inflammation. These conservative options aim to monitor the condition and potentially slow its progression.
For advanced cases (Baker Grades III and IV), surgical intervention is generally the most effective course of action. Primary surgical options include a capsulectomy (complete removal of the scar tissue capsule) or a capsulotomy (making incisions in the capsule to release tension). The original implant is often replaced during this procedure. Surgical management focuses on alleviating the pain and correcting the visible distortion.