Capsular Contracture

Capsular contracture occurs when the scar-tissue capsule around a breast implant becomes unusually firm and tight. The body normally forms a capsule around every implant as part of healing, but this capsule can thicken and contract. The condition may cause changes in how the breast feels, looks, or moves. It can happen after breast augmentation or breast reconstruction.

The body naturally forms a fibrous capsule around a breast implant. In some people, inflammation or other healing factors cause this capsule to thicken and contract, which can make the breast feel firm and distort the implant. The exact cause is often multifactorial, and a specific cause may not be identifiable in an individual case.

Biological and surgical contributors

Possible contributors include infection or low-grade bacterial contamination, including theories involving bacterial biofilm, bleeding or a hematoma, implant rupture, radiation-related tissue changes, implant characteristics, implant placement, and an individual healing response. Some associations are better established than others, and research continues into how these factors interact. Your treating surgeon can review which contributors may be relevant to your history.

Having one or more risk factors does not mean capsular contracture will develop. A surgeon should individualize implant and procedure choices based on your health, anatomy, prior treatment, and goals.

Severe or painful contracture warrants medical evaluation. A clinician should also distinguish capsular contracture from urgent postoperative problems such as infection, bleeding, or implant rupture.

Diagnosis is usually clinical. The clinician reviews your implant and surgical history, asks when symptoms began and whether they are progressing, and examines breast firmness, shape, position, and symmetry. These findings help identify signs of capsular contracture and guide next steps.

Tests for other implant problems

Ultrasound or MRI may be used when implant rupture, fluid, a mass, or another condition needs evaluation. The clinician may also assess for infection, hematoma, or seroma and, when clinically appropriate, investigate rare implant-associated malignancy. Testing depends on the examination and your symptoms.

Capsular contracture treatment depends on the severity of the change, pain or distortion, implant condition, previous surgery, and your goals. Mild, painless cases may be monitored, while painful, deforming, progressive, or recurrent cases may need revision surgery after examination and discussion with a qualified plastic surgeon.

Capsulotomy or capsulectomy

A capsulotomy releases cuts in the tightened capsule, while a capsulectomy removes part or all of the capsule. These procedures may be considered when the capsule is causing significant firmness, pain, or distortion. The implant may be exchanged or repositioned when appropriate. Recovery commonly includes temporary swelling, discomfort, activity restrictions, and follow-up visits; risks include bleeding, infection, implant problems, and recurrence.

Implant removal or alternative reconstruction

Implant removal alone, removal followed by replacement, fat grafting, or another reconstructive approach may be considered when preserving the implant is unsuitable or not desired. The choice depends on the capsule, implant condition, available tissue, previous reconstruction, and personal preferences. Recovery and results vary, and no approach can promise that contracture will never return.

Mild cases may remain stable and can sometimes be monitored. Painful or severe cases often improve after appropriate treatment, although improvement in symptoms does not eliminate the possibility of recurrent capsular contracture. Long-term management is individualized.

Factors that influence the outlook

Severity, implant condition, prior radiation or reconstruction, infection or bleeding, the chosen revision approach, general health, recovery, and follow-up can influence healing and recurrence risk. Your surgeon can discuss likely outcomes based on your implant history and treatment goals.

Arrange a clinical appointment for new or worsening firmness, pain, tightness, breast asymmetry, visible distortion, implant displacement, or concern that an implant has ruptured. These signs of capsular contracture and other implant problems need assessment rather than self-diagnosis.