Summary

• Capsular contracture is the excess growth and hardening of the scar tissue surrounding a breast implant
• It is a relatively rare side-effect, with 1-2% of cases requiring treatment
• Symptoms of capsular contracture include tightness and firmness in the breasts and a change in shape or position
• Capsulectomy surgery, combined with Breast Implant Removal or Replacement, is the best treatment option for most patients
• Cadogan Clinic has brought together a team of specialist Consultant Breast Surgeons who are experts in treating capsular contracture

What is Capsular Contracture?

Capsular contracture is the atypical hardening of the scar tissue which forms around a breast implant.

Cadogan Clinic’s team of specialist Consultant Breast Surgeons are experts in all areas of breast surgery, including addressing unwanted side effects, such as capsular contracture. 100% of Cadogan Clinic’s surgical patients would recommend the Clinic to their friends and family.

Once a breast implant is in place, it is normal for a layer of scar tissue to form during the healing process, surrounding the implant, known as a capsule. This is the body’s natural response to any object it recognises as foreign, providing protection and holding the implant in place.

However, in some cases, the capsule of scar tissue can become hardened and tight, causing pain and distortion in the appearance of the breasts. As well as being physically uncomfortable, capsular contracture can take away from the positive impacts of breast surgery, affecting confidence and making individuals question whether they made the right decision in having breast surgery.

Capsular contracture typically develops within 6-12 months of surgery, but symptoms may not noticeably develop for several years.

Although it may sound alarming that capsular contracture is the most common complication following breast implant surgery, it is important to remember that it is reported that less than 2% of patients require treatment for capsular contracture. 

Capsular contracture is highly treatable, and fear of developing this condition shouldn’t deter you from undergoing breast surgery. For the vast majority of patients, breast surgery is highly beneficial both functionally and aesthetically, and these benefits dramatically outweigh the risk of capsular contracture.

If you are concerned about capsular contracture, Cadogan Clinic’s specialist surgical patient advisors are available to discuss your options and match you with the best Consultant Breast Surgeon to address your concerns.

Baker Classification of Capsular Contracture

When assessing capsular contracture, surgeons use a clinical grading scale called the Baker classification to determine the severity of the hardening of the scar tissue.

The Baker capsular contracture grades are:

• Grade I: The capsule has developed normally, the breast remains soft, natural-feeling and looks normal
• Grade II: The breast feels slightly firm to the touch, but looks normal and is not visibly distorted
• Grade III: The breast is noticeably firm and visibly distorted, but usually not painful or tender
• Grade IV: The breast feels hard, is visibly distorted and is tender or painful

In most cases, Grades I and II require ongoing monitoring, whereas Grades III and IV may call for further intervention.

If you are concerned about capsular contracture, it is important to be aware of the Baker classification to understand how the condition may develop. 

Capsular contracture is an unwanted side effect which can arise from any surgery involving breast implants, where the natural protective capsule of scar tissue formed by the body becomes unusually hardened, resulting in physical discomfort and a loss of confidence.

What Causes Capsular Contracture?

Capsular contracture doesn’t have a single distinct cause, and clinicians believe the cause can vary between patients.

It is important to understand that capsular contracture is not caused by breast implants being toxic or dangerous. However, it is normal for individuals to respond differently to foreign implants in the body due to a range of immune system triggers.

Factors which may cause, or increase the risk of capsular contracture from developing include:

Genetics

It has been noted that genetics may play a significant role in determining who may have a higher risk of developing capsular contracture.

Your surgeon will discuss the following factors during your consultation to assess your personal risk:

• Family history of autoimmune conditions
• Relatives who are known to develop thick scar tissue following injury
• Family members who have previously developed capsular contracture

If any of these apply to you, there may be a slightly higher chance of capsular contracture arising, but it can also develop randomly in patients with no family history of associated concerns.

Due to capsular contracture being highly treatable and relatively rare, patients shouldn’t allow the experience of a relative to entirely influence their decision to undergo a transformational surgery. However, it is important to bear it in mind.

Biofilm

Biofilm is a thin layer of staph bacteria that can develop around implants after being introduced during surgery.

The staph bacteria cause a chronic low-grade infection that often doesn’t result in noticeable symptoms. However, this causes excessive inflammation, resulting in more scar tissue around the breast implant, which can progress to capsular contracture.

It is important to remember that bacterial contamination during breast surgery is not necessarily caused by unhygienic working conditions. Many people naturally carry staph bacteria on their skin without ill effects. However, during surgery, bacteria can enter the body. Although maintaining a safe and clean working environment can help to lower the risk of staph contamination, it isn’t always possible to eliminate the bacteria fully.

Cadogan Clinic maintains industry-leading safety standards, including a surgical infection rate of 0.01% (compared to a national average of 4.7%).

Breast Implant Rupture

Rupture is another known risk of breast implant surgery and has been associated with the development of capsular contracture.

Although the silicone used in breast implants is medical-grade and completely safe, it has been known for the body to respond to leaking silicone with chronic inflammation, causing the scar tissue around the implant to thicken and tighten.

Breast implant ruptures are very rare, affecting less than 1% of patients each year. However, it is important to be aware of the impact a ruptured breast implant can have and the signs to be aware of.

Breast Implant Placement

It has been reported that placing breast implants over the pectoral muscle, instead of under, is more likely to lead to capsular contracture. Patients with breast implants placed under the muscle are around 6% less likely to develop capsular contracture.

It is believed that under-muscle breast implant placement is less likely to result in capsular contracture as the breast implant is given more support, reducing movement and friction, which may increase the development of inflammation and scar tissue.

Your surgeon will discuss different options for breast implant placement with you during your consultation to help you make a fully informed decision about the potential risks and how to achieve your desired results.

Breast Implant Texture

Different brands make breast implants in a range of textures to achieve different results depending on a patient’s concerns and desired outcomes. Using breast implants with a textured surface, rather than a smooth surface, has been connected with a lower risk of capsular contracture developing.

It is understood that textured breast implants prevent movement and reduce the amount of thick scar tissue that can develop around the implant. This prevents capsular contracture from occurring.

However, textured breast implants may not be suitable for all patients, and your surgeon will discuss the options with you during your consultation.

Radiation Therapy

Patients who have undergone radiation therapy for cancer treatment may have a higher risk of developing capsular contracture.

Breast implants are a popular method for reconstructing the breasts following breast cancer, but it is important to discuss how your wider cancer treatment may impact breast implants. In cases where a patient has previously had breast implants inserted and later required radiation therapy, the risk of capsular contracture developing is higher than in patients who have had breast implants inserted after radiation therapy.

Depending on your circumstances, your surgeon may ask you to wait a certain amount of time after radiation therapy before having breast implant surgery. If you require radiation therapy and already have breast implants, it is essential that you discuss this with your medical team so they are aware and can support you.

Although it isn’t always possible to predict when capsular contracture may develop, there are a number of causes that it is important to be aware of and discuss with your surgeon if you are concerned that they may affect you.

Capsular contracture causes range from genetics to medical treatments, and it is important to be aware of how they may affect your personal risk.

How to Fix Capsular Contracture?

Capsular contracture treatment is most often surgical; however, your treatment plan will depend on the severity of the condition and its impact on your life. It is normal for lower grades of capsular contracture to be carefully monitored over time to ensure that it isn’t worsening, but surgical intervention may not be required.

If you are concerned that you may have developed capsular contracture, it is important to first approach the surgeon who originally inserted your breast implants to allow them to offer a solution. However, if this isn’t possible, it is normal for capsular contracture to be treated by a different surgeon. Cadogan Clinic’s team of UK-leading Consultant Breast Surgeons regularly perform capsular contracture surgery for patients who previously saw a different surgeon.

There are different options for patients to consider to treat capsular contracture, but all capsular contracture surgery, will involve a breast capsulectomy.

What is Capsulectomy?

Capsulectomy is a surgical procedure which involves removing the excess firm scar tissue that has built up around the breast implant. There are different types of Capsulectomy depending on a patient's concerns and requirements:

• Total Capsulectomy: Complete removal of the scar tissue capsule surrounding the breast implant
• En Bloc Capsulectomy: Complete removal of the scar tissue capsule, but in one single unit (often performed when there is a concern about malignant tissue to prevent spread)
• Partial Capsulectomy: Removal of only thickened and problematic portions of scar tissue around the breast implant. This may be suitable in cases where capsular contracture has been detected early

The type of capsulectomy that your surgeon recommends will depend on the severity of the capsular contracture and what you wish to achieve following surgery.

Capsulectomy surgery can be combined with different procedures depending on the patient’s preference.

Breast Implant Replacement

Breast Implant Replacement involves removing the previous breast implants and replacing them with new implants. Alongside a Capsulectomy, the excess scar tissue can be removed to allow a new breast implant capsule to form around the replacement implants.

For patients who are considering Breast Implant Replacement due to capsular contracture, it is important to discuss the potential causes with your surgeon to determine whether you may need to choose a slightly different type of breast implant or technique to prevent capsular contracture from recurring:

• If you previously had smooth breast implants, your surgeon may suggest textured implants
• If your breast implants were originally placed over the muscle, your surgeon may recommend under-muscle or hybrid placement

It is important to remember that even though making changes to the type and placement of the breast implants may reduce the risk of capsular contracture from recurring, it cannot be guaranteed, and some people may just be more prone to the condition developing than others.

Breast Implant Removal

Breast Implant Removal is a surgical procedure that involves removing existing breast implants but not replacing them with new implants. During a removal of breast implants, a Capsulectomy is also performed, by removing the scar tissue around the breast implants.

Breast Implant Removal may be the most suitable option for patients whose capsular contracture is connected with genetics or medical treatment, such as radiation therapy, and there is a greater risk of the hardened scar tissue reforming.

Many patients are concerned that if they remove their breast implants, their breasts will appear saggy and lacking volume. To counter this, Breast Implant Removal is often combined with a Breast Lift (also known as a Mastopexy) to enhance the appearance of the breasts following the removal of breast implants.

Both Breast Implant Replacement and Breast Implant Removal are commonly combined with Capsulectomy as part of capsular contracture surgery, depending on the severity of a patient’s condition and their desired results.

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