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What is Capsular Contracture? An In-Depth Look at This Breast Augmentation Complication

Capsular Contracture: Top 3 Causes and Treatments in 2024

What You Need to Know About Capsular Contracture

If you’re wondering what capsular contracture is, you’ve come to the right place. In simple terms, capsular contracture is a potential complication following breast augmentation surgery. It occurs when the body forms a tight, fibrous capsule around a breast implant, which can lead to pain, hardness, and distortion of the breast’s appearance. Here’s a quick snapshot:

  • Definition: The formation of a tight, fibrous capsule around a breast implant.
  • Symptoms: Pain, hardening, and change in the shape of the breast.
  • Importance: Understanding it can help you make informed decisions about breast augmentation and tackle concerns swiftly if they arise.

Hi, I’m Dr. Mark Anton, founder of OC Breast Surgery. With over three decades in practice and specialization in breast surgery, I’ve seen how capsular contracture can impact both the aesthetics and comfort of patients. Let’s dive deeper into what this condition entails.

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Understanding Capsular Contracture

The Role of the Immune System

Capsular contracture is a complication arising from the body’s immune response to foreign materials like breast implants. When an implant is placed in the body, the immune system springs into action to protect the body. It does this by forming a capsule of tightly woven collagen fibers around the implant. This capsule acts as a barrier, isolating the foreign object.

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However, the immune response can sometimes go overboard. The collagen-fiber capsule may shrink and tighten, compressing the implant and causing discomfort. This is what we call capsular contracture.

Common Triggers of Capsular Contracture

Understanding what triggers capsular contracture can help in taking preventive measures. Here are some common triggers:

  • Bacterial Contamination: Even a small amount of bacteria introduced during surgery can cause inflammation and lead to contracture. This is why sterility during surgery is crucial.

  • Implant Rupture: When the implant shell ruptures, it can leak silicone or saline into the surrounding tissue. This leakage can provoke the immune system, leading to contracture.

  • Hematoma: A collection of blood around the implant, known as a hematoma, can also trigger an immune response. This can occur due to surgical trauma or post-operative complications.

Pathogenesis, Immune Response, and Fibrosis

The pathogenesis of capsular contracture is multifactorial, involving a complex interplay of immune responses and fibrosis. Fibroblasts, a type of cell that produces collagen, accumulate at the contact zone between the implant and the capsule. Over time, these fibroblasts produce more collagen, thickening the capsule.

The orientation and organization of collagen fibers change as contracture severity worsens. Initially, the fibers are uniformly distributed, but as the condition progresses, they form thicker, cable-like bundles. These bundles compress the implant, causing pain and deformity.

Key Factors in the Pathogenesis:

  • Foreign Materials: The presence of an implant is a foreign object that the body tries to isolate.
  • Collagen Fibers: These fibers form the capsule and can shrink and harden, leading to contracture.
  • Immune Cells: Macrophages and lymphocytes are involved in the immune response, contributing to fibrosis.

In summary, capsular contracture is a complex condition involving the body’s immune system and various triggers. Understanding these can help in managing and preventing this common complication.

Next, we’ll explore how capsular contracture affects breast augmentation and the different grades of severity.

How Capsular Contracture Affects Breast Augmentation

Grades of Capsular Contracture

Capsular contracture can significantly impact the results of breast augmentation, affecting both aesthetics and comfort. Let’s break it down into the different grades of severity:

Grade I: At this stage, the breast feels normal and looks natural. The capsule around the implant is thin and flexible, causing no visible or tactile issues.

Grade II: Here, the breast feels slightly firm but still looks normal. The capsule is starting to tighten, but the changes are minimal and often only noticeable by the surgeon.

Grade III: This grade involves more noticeable firmness and an abnormal appearance. The tightening capsule can cause the breast to look distorted. Patients might start to experience discomfort.

Grade IV: At this most severe stage, the breast becomes hard, painful, and looks significantly distorted. The capsule has contracted tightly around the implant, causing considerable discomfort and visible changes.

Aesthetic Impact

Capsular contracture can change the look of the breast. As the capsule tightens, the breast can appear misshapen or unnaturally high on the chest. This is most evident in Grades III and IV, where the distortion becomes more pronounced.

Pain and Discomfort

Pain is a key symptom, especially in the more severe grades. The tightening capsule can cause the breast to feel hard and sore. This discomfort can interfere with daily activities and lower the quality of life.

Breast Distortion

Breast distortion is a common issue with capsular contracture. As the capsule tightens, it can pull the implant into an unnatural position. This distortion is most visible in Grades III and IV and can be distressing for patients.

Understanding these grades and their impacts can help patients recognize early signs and seek timely treatment. Next, we will discuss the preventative measures and treatment options available for managing capsular contracture.

Preventative Measures and Treatment Options

Non-Surgical Treatments

Sterility During Surgery

Maintaining a sterile environment during surgery is crucial to prevent infections that can lead to capsular contracture. Using antibiotic irrigation and ensuring that all surgical instruments are sterilized can minimize the risk of bacterial contamination. Although some studies have shown mixed results with antibiotic irrigation, it’s a standard practice to reduce infection risk.

Postoperative Care

Proper postoperative care is essential. This includes following your surgeon’s instructions carefully, taking prescribed antibiotics, and avoiding activities that could raise blood pressure or heart rate for at least two and a half weeks. Hydration and a whole foods diet also support healing.

Massage and Ultrasound

Non-surgical treatments like massage and ultrasound therapy can help manage early-stage capsular contracture.

  • Massage: Regular breast massage can help keep the capsule flexible and prevent it from hardening. Your surgeon will provide specific techniques and frequency.

  • Aspen Multi-Energy Therapy: This ultrasound-based treatment aims to increase the elasticity of the capsule, making the breast softer and more pliable.


Medications such as anti-inflammatory drugs can sometimes help reduce the symptoms of capsular contracture. However, their effectiveness varies, and they are generally more helpful in the early stages.

Surgical Interventions


A capsulectomy involves the surgical removal of the thickened capsule around the implant. This procedure is often recommended for Grades III and IV capsular contracture. While effective, there’s a risk of recurrence, with some studies showing a recurrence rate of up to 25% within the first year.

Implant Replacement

Sometimes, replacing the implant can help. Newer implants, especially those with a textured surface, may reduce the risk of future contracture. In some cases, implants coated with special materials like collagen are used to prevent hardening of the scar tissue.

Submuscular Placement

The placement of the implant can significantly impact the likelihood of developing capsular contracture. Submuscular placement, where the implant is placed behind the pectoralis major muscle, has been shown to have a lower incidence of capsular contracture compared to subglandular placement. A recent review found that the rate of capsular contracture was 2.8% for submuscular placement, compared to 8.6% for subglandular placement.

Neopocket Formation

A newer surgical technique involves creating a “neopocket” in the subpectoral plane. This method allows the use of the existing capsule while creating a new vascularized pocket for the implant. Studies have shown this technique to have a high success rate in reducing contracture and maintaining soft breasts over time.

By understanding and utilizing these preventative measures and treatment options, patients can better manage or even avoid the complications of capsular contracture.

Next, we will address some frequently asked questions about capsular contracture.

Capsular Contracture: FAQs

What Are the Signs of Capsular Contracture?

Capsular contracture can be tricky to spot at first. However, there are some telltale signs you should be aware of:

  • Firmness: The breast may feel unusually firm or hard.
  • Shape Change: The breast may start to look different, appearing more rounded or misshapen.
  • Pain: You may experience discomfort or pain, especially in more severe cases.
  • Position Change: The implant might shift and sit higher than before.

If you notice any of these symptoms, it’s important to consult your doctor right away.

What Causes Capsular Contracture?

The exact cause of capsular contracture is still a bit of a mystery. However, several factors are believed to contribute:

  • Bacterial Contamination: Even a small amount of bacteria introduced during surgery can trigger an immune response.
  • Implant Rupture: A damaged implant can lead to inflammation and fibrosis.
  • Hematoma: Blood accumulation around the implant can cause the body to react defensively.

These factors can lead to an excessive fibrotic reaction, causing the capsule around the implant to thicken and harden.

How Common is Capsular Contracture?

Capsular contracture is the most common complication following breast augmentation surgery. Studies show that it affects about 1 in 6 women who undergo the procedure. Incidence rates vary widely, ranging from 2.8% to 20.4% in different studies. It’s important to note that the severity can vary, and not all cases require intervention.

Can Capsular Contracture Be Prevented?

While it’s impossible to prevent capsular contracture completely, several measures can significantly reduce the risk:

  • Sterility During Surgery: Using techniques like the Keller Funnel to minimize contamination.
  • Proper Implant Placement: Placing the implant under the chest muscle can lower the risk.
  • Postoperative Care: Regular breast self-massage can help keep the capsule flexible and soft.

How Is Capsular Contracture Treated?

Treatment depends on the severity of the condition:

  • Non-Surgical Treatments: Options like breast massage and Aspen multi-energy therapy can be effective for mild to moderate cases.
  • Surgical Interventions: Severe cases may require a capsulectomy (removal of the capsule) and implant replacement. Sometimes, placing the implant in a new submuscular pocket is recommended.

Can Capsular Contracture Recur After Treatment?

Unfortunately, capsular contracture can recur even after treatment. The recurrence rate varies, but employing preventative measures during and after surgery can help reduce this risk. Newer techniques and materials, such as acellular dermal matrices and polyurethane-coated implants, show promise in reducing recurrence rates.

Next, we’ll delve into some common signs and symptoms of capsular contracture and explore the various treatment options available.


At OC Breast Surgery, we understand the complexities and challenges that come with capsular contracture. Our team is dedicated to providing expert care and effective solutions to ensure the best possible outcomes for our patients.

Expertise in Correction

Our board-certified plastic surgeons are highly skilled in diagnosing and treating capsular contracture. With years of experience and a deep understanding of the condition, we employ the latest techniques and materials to minimize the risk of recurrence. Whether it’s through a capsulectomy, implant replacement, or innovative approaches like submuscular placement, we tailor our treatments to each patient’s unique needs.

Natural-Looking Results

Our primary goal is to help you achieve natural-looking results that enhance your confidence and well-being. We take pride in our meticulous approach to breast surgery, ensuring that every procedure is performed with precision and care. By using advanced surgical techniques and materials, we strive to create beautiful, lasting results that look and feel natural.

If you’re experiencing symptoms of capsular contracture or considering breast augmentation, we invite you to consult with our expert team. Learn more about our breast augmentation services and how we can help you achieve your desired outcomes.

Your journey to feeling comfortable and satisfied with your appearance starts here.