The body's natural healing process
When a breast implant is inserted to the body during breast augmentation or breast reconstruction surgery, the body's immune system recognises it as a foreign body and "wraps" it – forming a "capsule" of scar tissue. The formation of such a capsule around any kind of implant (medical or cosmetic) is a normal part of the body's healing process. (1,2)
With breast implants, this is usually a good thing – as the capsule helps to keep the breast implants in place, preventing slippage. (1)
What is capsular contracture?
In some instances, the capsule that forms around the implant can become hard and contract, resulting in a complication known as capsular fibrosis or capsular contracture.
With an overall incidence of more than 10% across implants, capsular contracture is the most common complication following implant-based breast surgery and is one of the most common reasons for reoperation. (3)
What is the cause for capsular contracture?
Capsular contracture is believed to be an inflammatory reaction which causes fibrosis through the production of collagen, ultimately leading to firm breasts and, in some cases, pain (4).
Capsular contracture is classified in four grades – called the Baker grade – according to their severity: (5)
- Baker grade I: This is the natural capsule that forms around a foreign body; it shows no negative effects.
- Baker grade II: The capsule becomes firmer and palpable.
- Baker grade III: The capsule is not only clearly palpable but also visible beneath the skin and the implants start to deform.
- Baker grade IV: The capsular contracture and deformation become even more evident. Additionally, pain will develop.
Baker grades III and IV of capsular contracture are considered clinically relevant and requiring re-operation.
Can I do something to prevent capsular contracture from happening?
Studies have shown that there is a reduced risk of capsular contracture with the use of textured implants, submuscular placement and the use of polyurethane-covered implants. (4)
Capsular contracture rates can reach up to 50% with smooth implants, whereas the rate for polyurethane-foam-covered implants can be as low as 0-3%. (7)
POLYTECH’s Microthane® implants (micro-polyurethane covered) have shown a very low risk of capsular contracture, even in cases of radiation treatment, which is known to dramatically increase the risk of capsular contracture (6,7). Implants with a microtextured surface such as our MESMO® and POLYtxt® implants have also shown a reduced risk of capsular contracture.
If you have concerns about capsular contracture, it is advisable to have an open discussion with your surgeon, who will be able to guide you on the best course of action for your specific case.
How is capsular contracture treated?
Recent research has focused on preventing capsular contracture from occurring in the first place. (4)
A medical procedure is never without its risks, but as mentioned above, chances of a capsular contracture can be greatly reduced by choosing the right implant and the right implant placement.
Once capsular contracture has already happened and it is symptomatic, it is usually managed surgically, with a procedure called capsulectomy or capsulotomy. (4)
A capsulectomy is the surgical removal of the capsule. During this procedure, the breast implant is removed and can be replaced if desired by the patient. (6)
Implants of Excellence
In the event of capsular contracture, patients who have POLYTECH implants and are registered in our Implants of Excellence programme have certain benefits, such as being eligible for free replacement implants in the event of Baker III or IV capsular contracture:
- Up to 10 years post-surgery for all breast implants with the following surfaces: MESMO®, POLYtxt®, POLYsmoooth™
- For lifetime, including rotation, for all breast implants with a Microthane® surface.
Learn more about our Implants of Excellence warranty here >>
(2) Bachour, Y. Capsular Contracture in Breast Implant Surgery: Where Are We Now and Where Are We Going?. Aesth Plast Surg 45, 1328–1337 (2021). https://doi.org/10.1007/s00266-021-02141-6
(4) Headon H, Kasem A, Mokbel K. Capsular Contracture after Breast Augmentation: An Update for Clinical Practice. Arch Plast Surg. 2015 Sep;42(5):532-43. doi: 10.5999/aps.2015.42.5.532. Epub 2015 Sep 15. PMID: 26430623; PMCID: PMC4579163.
(5) Baker JL (1978) Augmentation mammoplasty. In: Owsley JQ, Peterson RA (eds) Symposium on aesthetic surgery of the breast. Mosby, St Louis, p 272
(7) Handel, N., Cordray, T., Gutierrez, J., Jensen, J.A. (2006) A long-term study of outcomes, complications, and patient satisfaction with breast implants. PRS 117,757 et seq.; Kjoller, K., Holmich, L.R., Jacobsen, P.H., Friis, S., Fryzek, J., McLaughlin, J.K., Lipworth, L., Henriksen, T.F., Jorgensen, S., Bittmann, S., Olsen, J.H. (2002) Epidemiological investigation of local complications after cosmetic breast implant surgery in Demark. Annals of Plastic Surgery 48(3), 229-237; Malata, C.M., Feldberg, L., Coleman, D.J., Foo, I.T., Scarpe, D.T. (1997) Textured or smooth implants for breast augmentation? Three-year follow-up of a prospective randomised controlled trial. British Journal of Plastic Surgery 50(2), 99-105; Tebbetts, J.B. (2001) A surgical perspective from two decades of breast augmentation. Clinics in Plastic Surgery 28(3), 425-434; Young, V.L., Nemecek, J.R., Nemecek, D.A. (1994) The efficacy of breast augmentation: breast size increase, patient satisfaction, and psychological effects. Plast. Reconstr. Surg. 94, 958-969; Hohlweg-Majert (1991) AWO-Jahrestagung, Baden-Baden; Spear, S.L., Mesbahi, A.N. (2007) Implant-based reconstruction. Clinics in Plastic Surgery.