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Marietta, GA 30068


    Capsular Contracture

    Capsular contracture is a complication that can occur with breast implants even when surgery has been performed flawlessly. It can occur at any time but most frequently in the first months following surgery. Capsular contracture is the name given when the tissue surrounding the implant, the capsule, hardens. During breast implant insertion a pocket is created, which during the healing process forms a capsule. Under normal conditions this pocket will remain open and allow the implant to look and feel natural, however in capsular contracture this capsule hardens and presses on the implant causing the implant to feel firm and look unnatural, even though the implant itself remains unchanged. There is a grading system for the severity capsular contracture:

    – Baker Grade I – Breast is soft and looks natural. (normal conditions of a breast implant)

    – Baker Grade II – Breast feels a little firm but maintains natural appearance

    – Baker Grade III –  Breast is firm, may appear slightly distorted

    – Baker Grade IV – Breast is firm, distorted in shape and may be causing some pain/ discomfort.

    There are a number of theories as to why this occurs for some individuals from inflammation caused by bacterial contamination, smoking slowing the healing process and even implant placement – subglandular placement (above the pectoralis muscle) has a lot higher rate of capsular contracture than submuscular placement (below the pectoralis muscle).

    I see capsular contracture in only about 5% of my patients.  With our minimal touch techniques and new and improved breast implant construction, rates of capsular contracture are at an all-time low.  Despite seeing very low capsular contracture rates in my own patients, I do see a fair number of patients with older implants (10-30 years) or implants placed in foreign countries who present with this complication.  I highly recommend that if a patient has had implants for more than 10 years or if the implants were placed in a foreign country, that patient should see a plastic surgeon about possible complications.  With both groups of patients I see high rates of implant rupture and capsular contracture and the patients often need further corrective surgery or implant exchange for new breast implants.

    Capsular contracture is a vexing problem for both the patient and the physician.  I explain to patients about the risk of capsular contracture before surgery but I know they don’t fully understand what it is or why it happens.  We as physicians don’t fully understand why it happens.  I tell patients that put simply, capsular contracture is hardening of the capsule of tissue around the breast.  As the capsule hardens the implant will become less mobile and it can be painful in later stages.

    Theories for the cause of capsular contracture fall into two basic categories:  inflammatory or infectious.  The truth is that it’s most likely a combination of these categories.  What we know is that if we perform 100 breast augmentations using precisely the same technique in all cases, 1-10 people will develop capsular contracture in at least one side.

    If we notice post-operatively that one breast is more firm than the other, we may opt to treat that patient with medicine (corticosteroids such as oral prednisone).  If this doesn’t resolve the capsular contracture then we proceed with capsulectomy surgery to remove the thickened, scarred capsule and replace the breast implant with a new implant.  Patients who have had capsular contracture in the past are at higher risk to develop it again, even after the capsulectomy surgery so we monitor them carefully for any changes in the implant.

    Any possible complications of surgery are discussed with each patient during their consult before surgery so that patients are fully aware and informed.

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