What Is Capsular Contracture?
Whenever a breast implant is placed in the body, the surrounding tissue naturally forms a thin layer of scar tissue, known as a capsule, around it. This is a normal healing response. Capsular contracture occurs when that scar tissue thickens and tightens abnormally, squeezing the implant. This can cause the breast to feel firm, look distorted, or become uncomfortable or painful.
Capsular contracture is one of the most common long-term complications following breast augmentation or reconstruction, and it can develop months or even years after the original surgery. Dr. Eugene Kim, a double board-certified plastic surgeon in Beverly Hills, regularly evaluates and treats capsular contracture in patients who received their original implants elsewhere as well as his own patients.
What Causes Capsular Contracture?
The exact cause isn’t fully understood, but research points to several contributing factors:
- Subclinical bacterial contamination (biofilm) around the implant at the time of surgery
- Hematoma or seroma (blood or fluid collection) forming around the implant during healing
- Implant surface texture and shell type
- Placement of the implant above versus below the chest muscle
- Individual healing response and genetic predisposition
- Trauma, radiation exposure, or prior infection near the implant
Baker Grading Scale
Surgeons classify capsular contracture severity using the Baker Grading Scale:
- Grade I — The breast feels as soft as a natural breast; no visible or palpable firmness
- Grade II — The breast is slightly firm but appears normal in shape
- Grade III — The breast is firm and visibly distorted, altered, or misshapen
- Grade IV — The breast is firm, distorted, and painful or tender to the touch
Signs and Symptoms to Watch For
Patients with capsular contracture often notice one or more of the following changes:
- A breast that feels firm and less mobile when massaging
- Visible rippling, distortion, or a rounder-than-normal shape
- One breast sitting higher or appearing different from the other
- Discomfort, tightness, or pain, particularly in more advanced grades
Treatment Options for Capsular Contracture
Treatment depends on the severity of the contracture and the patient’s goals. Dr. Kim tailors a plan after a full evaluation, which may include imaging to rule out implant rupture.
Capsulectomy
In most surgical cases, Dr. Kim performs a capsulectomy — removal of the thickened scar capsule — rather than simply releasing it (capsulotomy), as removal is associated with lower recurrence rates. This is often combined with implant replacement.
Implant Replacement or Removal
Many patients choose to have their implants replaced at the time of capsulectomy, sometimes with a different implant type, surface, or placement plane to reduce the risk of recurrence. Some patients opt to have implants removed entirely, sometimes paired with a breast lift for a natural contour.
Change in Implant Pocket (Site Change)
Moving the implant to a new plane, such as from above the muscle to below it (or vice versa), can reduce the likelihood of recurrent contracture in select cases.
Acellular Dermal Matrix (ADM)
In certain revision cases, Dr. Kim may use ADM (Strattice), a supportive tissue graft, to reinforce the implant pocket and help lower the risk of recurrent capsular contracture.
Can Capsular Contracture Be Prevented?
While no technique eliminates the risk entirely, meticulous surgical technique can meaningfully reduce it. Dr. Kim follows protocols associated with lower contracture rates, including careful sterile handling of implants, placement of Strattice, minimizing tissue trauma, and selecting implant surfaces and pocket planes suited to each patient’s anatomy.
Frequently Asked Questions
Is capsular contracture dangerous?
Capsular contracture is not typically dangerous to your overall health, but it can cause discomfort, aesthetic changes, and in more advanced grades, pain. Persistent firmness or distortion should always be evaluated by a board-certified plastic surgeon.
Can capsular contracture happen more than once?
Yes, recurrence is possible, particularly after simple capsulotomy. This is why Dr. Kim generally favors capsulectomy with implant replacement and, when appropriate, a change in implant pocket to reduce the chance of it happening again. He has had great success in lowering the risk of recurrence using Strattice.
How soon after breast augmentation can capsular contracture develop?
It can develop at any point during healing, though it most often becomes noticeable within the first one to two years after surgery. It can also occur many years later.
Do Motiva implants reduce the risk of capsular contracture?
Some newer implant surface technologies, including those used in Motiva implants, have been associated with lower reported rates of capsular contracture in clinical data. Dr. Kim can discuss whether this is a suitable option if you are undergoing revision surgery.