One of the banes of the cosmetic plastic surgeon’s existence is the formation of scar tissue or a capsule around a breast implant.  We know little about why it occurs and nothing about why it only affects some people. We don’t know why our treatments help some patients and why it recurs in others.

The capsule, or scar tissue,  is in fact a normal response of the body to a foreign object. The body essentially walls off whatever foreign material is placed into it, be it a breast implant or a pacemaker. With breast implants, however, the capsule seems to be a little different than normal scar tissue. In 10% of cosmetic patients with breast implants, be they silicone or saline, the capsule contracts (hence the term “capsular contracture”)! There are actually smooth muscle cells that have been found in the scar tissue of the capsule, and these are the cells that contract. These smooth muscles then squeeze down on the soft and squishy breast implant and cause a series of unwanted problems that have been classified by the Baker system of breast capsule formation. The breast first becomes firm, then progressively hard and deformed and finally causes pain. 90% of cosmetic patients who develop contractures do so during the first year after surgery.

Another puzzling fact is that the rate of breast capsular contracture is almost double for patients undergoing breast reconstruction with implants after treatment for breast cancer. No one has ever told me why.

The Baker classification for capsular contracture

Grade 1 – Normal breast capsule. The breast is soft, looks normal and feels normal.

Grade 2 – Normal appearance of the breast but the breast feels firm.

Grade 3 – Abnormal appearance of the breast. The breast is hard and deformed.

Grade 4 – Abnormal appearance of the breast. The breast is hard, deformed and painful.

Causes of capsular contracture

Did I mention that no one knows why some people get capsules that contract? A number of unproven theories exist, but the current favorite is that the scar tissue is transformed into a contractile state by a chronic infection in a bio-film that forms over the breast implant. But this is just a theory, though surgeons who pay extra attention to decreasing the bacterial contamination of the implant via contact with the skin are reporting lower rates of contracture. I routinely bathe the implants I use in a solution of antibiotics and steroids to decrease any reactions by the body and kill bacteria.

Making sure a large pocket is created by the plastic surgeon during the surgery also seems to be important. It makes sense that if a pocket is large, the breast capsule’s smooth muscle cells will have to contract a lot more to squeeze the implant. In cases where breast augmentations were performed through endoscopic techniques or through the belly button, the pocket created was small or non-existent and the capsular contracture rate was higher.

Morad Tavallali, M.D., FACS

6 Comments

  • Laura says:

    I have stage 4 by your website. Sometimes I cannot breathe because the abnormal implant which was caused by radiation squeezes and feels like my ribs are pushing on my lungs and hurts and scares me. Do I need to see my surgeon again?

    • Hi Laura and I’m sorry for you that you are having these troubles. Go and see you plastic surgeon as soon as possible. He or she will be able to perform a surgery to remove the capsule causing the problem and replace a new implant. Radiation will lead to greater complications with any breast surgery so unfortunately that part is not unusual. Wishing you the best of luck.
      Dr. Tavallali

  • sharon frost says:

    i have had my implants for 14 years and for the last 5 have been in excrutiating pain my boobs are so hard i can not even hug my grand children. I have tried to get them changed without sucsess by the nhs,I can not afford to pay private again, although i had letters from my pshychiatrist,pshycologist and the pain clinic it did no good, i have to live my life in pain.

    • So sorry to hear Sharon. You probably have capsular contracture. Scarring around the implant. One option may be to have the implants removed. Anotherbisntontrynandrug called Accolate in the US which can help in some cases. Worth a try! Good luck.

  • Mintu says:

    Hi.. I did breast implantation five years ago. Everything feels normal. But sometimes I feel like having any pain, pricking sensation, itching, hard feeling, or even like having capsule formation around my breast. I had followup with my doctor each year but she examines physically and says everything looks quite normal. But I am afraid whether anything would be serious.. Please help out

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