Capsular contracture: What is it? How is it treated? Questions and answers

Not every patient feels the same thing. Some of the signs we may see include:

• Increased firmness or hardening of the breast.
• A feeling of tightness around the implant.
• Changes in the shape or position of the breast.
• Noticeable differences between one breast and the other.
• Discomfort or pain.
• An implant that starts to feel stiffer than usual.

It’s important to remember that a firm breast after surgery doesn’t necessarily mean you have capsular contracture. During the early stages of recovery, swelling and changes in tissue texture are completely normal.

That’s why, if any change raises questions for you, the right next step is to have your surgeon evaluate it.

In general, we use four grades to describe the capsule around a breast implant.

• Grade I: this is actually normal. The capsule is thin, soft, and flexible. It doesn’t squeeze or distort the implant, and it causes no symptoms. This is what we see in most patients.
• Grade II: this happens when the scar tissue starts to get slightly thicker, causing mild firmness but no visible distortion or pain. In most cases, this only calls for careful monitoring, with treatment if the condition progresses.

• Grade III: this happens when the capsule gradually tightens and starts to distort the implant, causing a visible change in the shape or position of the breast.
• Grade IV: this includes the distortion seen in Grade III, but it also comes with discomfort or pain. Grades III and IV usually warrant a conversation about surgical treatment.

When capsular contracture requires surgery, there’s no one-size-fits-all solution. The decision depends on how advanced the contracture is, the condition of the implant and the surrounding tissue, and also on what the patient wants to achieve.

One option is to remove the implant for good. Some patients were already thinking about going implant-free, and developing capsular contracture can be what finally leads them to make that decision. In many cases, implant removal can help relieve symptoms and improve the change in breast shape caused by the capsule. If the tissue around the implant is very thick or shows calcifications, we may also consider removing part or all of the capsule.

Another option is to remove the implant and perform a capsulectomy, which means removing part or all of the capsule that has formed around the implant, and then placing a new implant. This option requires careful planning, because the capsule may also be giving the implant some support.

We can also consider changing the position of the implant. For example, if it was previously placed in front of the muscle, for some patients it may be better to place it behind the muscle to improve implant coverage and create better conditions to lower the risk of the contracture coming back.

That’s why, when I treat capsular contracture, I’m not only thinking about removing the tissue causing the problem. My goal is to rebuild the breast in a way that fits each patient’s anatomy.

The risk can’t be eliminated completely, but surgical techniques and implant technology have improved significantly since the early days of Breast Augmentation.

One major advance has been the development of a strict “no-touch” approach. This means we handle implants using meticulous sterile technique. The implant is never intentionally touched directly, gloves are changed before handling a new implant, and a sterile insertion funnel is used to place the implant into the prepared pocket.

Implant technology has also evolved. Some newer implant surfaces, including those used in Motiva implants, have been associated with low reported rates of capsular contracture. None of these measures brings the risk down to zero, but together they’ve helped make capsular contracture much less common than it used to be.

Recovery varies because surgery can range from a relatively simple Implant Removal to an extensive capsulectomy, implant exchange, pocket reconstruction, and mesh placement.

After a simple implant removal, some patients only need a day or two of rest, can get back to work quickly, and can often start easing back into exercise in about a week. In other cases, a patient who undergoes extensive reconstruction may need about two weeks off work, or even three weeks for a physically demanding job, and can expect to wait around a month before fully returning to the gym.

If you already have implants and suspect you may have capsular contracture, the first thing to do is not panic. What matters most is getting evaluated by a board-certified plastic surgeon who can review your history, examine your breasts, and determine what’s going on.

In some cases, monitoring may be enough; in others, Revision Surgery may be recommended. The decision will depend on your specific situation, your symptoms, and your goals.