What is Capsule Contracture?

Before we discuss capsule contracture, let’s examine what happens in the body following a breast augmentation.

Once the breast implant is placed within the body, the body will form a layer of scar tissue around it. This is your body’s way of walling off this foreign invader. The same thing happens regardless of whether this is a breast implant, pacemaker, or another type of medical implant.

Plastic surgeons call this scar tissue a capsule. From a surgeon’s perspective, a normal capsule looks like the thin membrane that surrounds the inside of a hard-boiled egg.  It is actually quite important for the capsule to form as this keeps the implant anchored in its position. In most patients, the capsule forms within a few weeks after surgery.

In most patients, the capsule remains very soft and supple. However, in some patients, the capsule can thicken and it can lose its elasticity. If this happens, it can make the breast seem firmer than ideal.

Plastic Surgeons call this condition where the capsule gets abnormally firm, capsule contracture. There is a range of firmness that is called Baker Grades. Baker Grade 1 is a breast that is perfectly soft. Baker Grade 4 is a breast that is very hard.

Abnormal firmness in the capsule (capsule contracture) can also cause pain and discomfort. This was much more common in the old-style implants that were used prior to the 1990s.  

Capsule contracture can also affect the position of the implant. It can cause the implant to sit higher on the chest wall than the patient and surgeon desire. Unfortunately, when capsular contracture occurs, it typically occurs on one side rather than on both. This results in breast asymmetry (unequal size and shape in the breasts).

Treatment Options

There are a variety of different treatment options for capsular contracture depending upon how long the contractor has been present, implant type, and implant position. If we note a capsule contracture forming in our own patients, aggressive massage and pressure on the implant may help improve the condition.

It has generally been recognized that putting implants under the muscle decreases the risk of capsule contracture, though there is some evidence recently that this may or may not be the case.

In general, Dr. Schneider recommends that if your implants are on top of the muscle and you have a capsular contracture, changing the position of the implant to under the muscle may be beneficial.

In addition, other options are available:

  1. Capsulotomy – the cutting of the capsule in multiple areas to release it
  2. Capsulotomy and placement of a steroid solution to decrease the risk of contracture reformation
  3. Changing the implant position to under the muscle
  4. Capsulectomy – excision rather than just cutting the capsule. This is a more extensive surgery
  5. Breast implant exchange along with capsulectomy – one of the theories of capsule contracture is that it is due to a film of bacteria that sits on the implant (biofilm). Removing the capsule and exchanging the implant may be a better way of clearing this biofilm.
  6. The above options, plus placement of acellular dermal matrix or galaflex mesh – this is a very expensive option as the acellular dermal and galaflex mesh are quite expensive.  This may or may not improve the results of treatment. In Dr. Schneider’s experience, though he has used these materials extensively in breast reconstructive cases, they do not seem necessary when treating capsule contracture.