Capsular Contracture Overview

Risks    Capsular Contracture Overview  

What is capsular contracture?

When breast implants, or any other foreign object, are placed in the body, the body forms a lining around it.  This lining, or capsule, is formed by your own living tissue.  Many people refer to this lining as the "capsule", "tissue capsule", or "scar capsule", although it is not exactly the same thing as scar tissue.  This is the body's natural response to a foreign object.  

Capsule contracture, the most common complication of breast augmentation surgery, can happen at any time, but seems to be more common in the first several months after surgery. At the time of the initial surgery, a pocket is made for the implant. During the healing process, a capsule forms, which is comprised of fibrous tissue. The body is genetically programmed to shrink scar tissue somewhat. Under normal conditions, the pocket remains open, thus allowing the implant to look and feel natural. However, in some people, the capsule will tighten, and squeeze the implant. This makes the breast implant feel hard, and distorts the appearance of the breast. In the later stages, the implant feels very firm, and may take on a "ball-like" look. It is important to remember that it is not the implant that has hardened. The shrinking of the capsule compresses the implant, causing it to feel firm/hard.   However, once the implant is removed, it is just as soft as it was the day it was inserted.


What causes capsular contracture?

Currently, the causes for capsule contracture are still very unclear. The following are thought to put you at greater risk for developing capsule contracture:

1) Transient germ contamination.  Germ contamination and/or long-term bacterial contamination of the implant shell can cause an inflammatory reaction, thus leading to the shrinking of the capsule.

2)  Subglandular placement.  Breast implants placed above the muscle tend to have higher capsular contracture rates, versus breast implants placed in behind the muscle, also known as submuscular placement.

3)  Infection.  Capsule contracture seems to be more likely following an infection.

4)  Seroma.  If you have had seroma, you may be at more risk for capsular contracture.

5)  Hematoma.  Hematomas can cause an inflammatory reaction, which can lead to capsule contracture.

6)  Smoking.  Smoking decreases the oxygen levels in the blood, which could result in delayed healing, and possibly an inflammatory reaction. 

Baker Grading System - 4 Grades of Capsular Contracture

  • Baker Grade 1 -  The breast is normally soft, and looks natural. (Basically, we all have this, since we all have a "capsule".) It is only when the capsule starts shrinking/contracting that capsule contracture occurs.
  • Baker Grade II - The breast is a little firm, but appears natural.
  • Baker Grade III - The breast is firm, and is beginning to appear distorted in shape. 
  • Baker Grade IV - The breast is hard, and has become quite distorted in shape. Pain/discomfort may be associated with this level of capsule contracture.