Capsular contracture is the most common complication of breast augmentation surgery, and it is also one of the most misunderstood. At E. Kim Plastic Surgery in Beverly Hills, double board-certified plastic surgeon Dr. Eugene Kim regularly evaluates and treats patients with capsular contracture, both women who had their augmentation elsewhere and patients whose implants he placed. Understanding what capsular contracture is, how it develops, and what can be done about it is important for any woman considering breast implants or currently living with them.
What Is a Capsule?
Every breast implant, regardless of type, size, or manufacturer, triggers a natural biological response. The body recognizes the implant as a foreign object and surrounds it with a thin layer of scar tissue called a capsule. This capsule formation is normal and actually serves a protective function. In most patients, the capsule remains thin, soft, and pliable, and the woman is unaware of its existence.
What Is Capsular Contracture?
Capsular contracture occurs when the capsule around the implant thickens, hardens, and begins to tighten, squeezing the implant and distorting the breast shape. It is classified by the Baker scale from Grade I to Grade IV:
- Grade I: The breast feels soft and looks natural. Normal capsule formation, no contracture.
- Grade II: The breast feels slightly firm but looks normal. Mild contracture.
- Grade III: The breast feels firm and looks abnormal, distorted shape or implant visible. Moderate contracture.
- Grade IV: The breast feels hard, looks distorted, and is painful. Severe contracture.
Grades I and II typically do not require treatment. Grades III and IV generally warrant surgical intervention.
What Causes Capsular Contracture?
- Subclinical bacterial contamination of the implant surface (biofilm) at the time of surgery
- Bleeding or hematoma formation around the implant after surgery
- Implant rupture
- Subglandular implant placement (above the muscle) carries a higher contracture risk than submuscular placement
- Radiation therapy to the breast
How Is Capsular Contracture Treated?
Capsulectomy (Capsule Removal)
The primary surgical treatment for symptomatic capsular contracture is capsulectomy, surgical removal of the thickened capsule. The implant is typically replaced at the same time. Dr. Kim evaluates each patient’s situation to determine the extent of capsule removal needed and whether implant exchange is appropriate.
Capsulotomy
A capsulotomy involves scoring or releasing the contracted capsule without removing it. This is a less extensive procedure and may be appropriate for milder cases, though contracture recurrence rates are somewhat higher than with capsulectomy.
En Bloc Capsulectomy
In cases where the implant has ruptured or in patients who want total capsule removal, an en bloc capsulectomy removes the implant and the surrounding capsule as a single intact unit. This is a more technically demanding procedure but may be preferred in specific clinical scenarios.
Can Capsular Contracture Be Prevented?
- Meticulous no-touch technique during implant placement
- Antibiotic irrigation of the implant pocket
- Submuscular implant placement
- Minimizing bleeding and ensuring hemostasis
- Post-operative implant massage protocols in appropriate cases
To discuss capsular contracture evaluation and treatment options with Dr. Kim, schedule a consultation at ekimplasticsurgery.com.
Dr. Kim provides capsular contracture evaluation and revision surgery to patients in Beverly Hills, Los Angeles, and the greater Southern California area. Contact E. Kim Plastic Surgery to schedule your evaluation.
Contact the Office of Beverly Hills Plastic Surgeon Dr. Eugene Kim
Click here see more plastic surgery procedures and treatments performed by Board Certified Plastic Surgeon, Dr. Eugene Kim on patients in Beverly Hills, Los Angeles, West Hollywood, Santa Monica, CA and surrounding areas or call 310-271-6996 to schedule a consultation.