What is capsular contracture?

After an implant is placed, the body creates a thin “case” of connective tissue around it. This is normal. Capsular contracture occurs when this case thickens and tightens. The breast becomes hard, higher, and rounder, moves unnaturally, and may hurt and tug. “Hard breasts” is not a compliment, but a complication.

How does it feel?

• Tightness and hardness, as if there was a hard ball inside.
• Change in shape – rounder, higher, often asymmetry with the other breast.
• Pain with pressure, sports, hugging, even at rest in more severe cases.
• It is visible under clothing: the breast does not "fall" naturally, there is no soft movement.

How often does it happen?

Simply put: the risk accumulates over time. As a guide, about 1 in 10 women with cosmetic implants will develop more severe contracture within 10 years. The risk is higher with reconstructions (especially after radiation therapy).

Why does it happen?

• Foreign body = constant stimulus. The implant is something artificial. The immune system isolates it. In some people, this reaction becomes too strong and tightness occurs.
• Microbial “film”. There may be a thin layer of bacteria (skin flora) around the implant. They do not cause an overt infection, but they maintain a mild, constant inflammation → the tissue thickens and tightens.
• Aging of materials . Over the years, the implant shell ages, microparticles pass through it ("bleed"). This irritates the tissues and increases fibrosis.
• Complications after surgery. Hematoma (blood), seroma (fluid), or true infection increase the risk.
• Implant position. Above the muscle (subglandular) carries a higher risk than below the muscle (dual-plane/submuscular).
• Radiation therapy : Greatly increases the risk of reconstruction.

Why does the risk increase with age?

Because the stimulus doesn't go away. The implant is there all the time. Low-grade inflammation + aging of the materials + micro-irritation = the tissue continues to process collagen and "tighten up". That's why we see more cases after 5-10-15 years than in the first year.

How to put "degree"

The doctor examines and evaluates on a Baker scale from I to IV:

I - soft and natural; II - slightly harder; III - hard and visibly changed; IV - hard, deformed and painful. In case of doubt, an ultrasound or MRI is performed.

What you can do to reduce the risk (if surgery or revision is yet to be performed)

- Choosing a surgeon who works with strict hygiene and "no-touch" technique.

- Rather under the muscle (if it's appropriate for your body), not over the muscle.

- Good control of bleeding and fluids during surgery.

- Avoiding an incision around the areola in case of high bacterial risk (the decision is individual).

- Informed choice of implant surface (today smooth ones are often preferred due to oncosafety).

Note : Post-operative massage is not a proven protection against contracture. It may help with comfort, but it is not a guarantee.

If you already have symptoms, what are the options?

• Observation in mild cases without pain.
• Medications (off-label) : Some doctors try medications that calm inflammation in the tissue (e.g. leukotriene antagonists) – they work for some people, mainly in early/mild cases. They have risks → only under medical supervision.
• Surgery :
  
• Open capsulotomy – “cutting”/releasing the capsule without removing it completely. More gentle, but recurrence is possible.
• Capsulectomy – removal of part or all of the capsule, often with replacement of the implant and/or change of “pocket” (e.g. from above the muscle → below the muscle). Major surgery, but more appropriate for severe/recurrent cases or suspected rupture.
• ADM (biomaterial) – sometimes placed as a “pad” to reduce the risk of re-tightening during revisions.
  
• What not to do: "Crushing" from the outside (closed capsulotomy) - increases the risk of tearing and other problems.

When to see a doctor

• If the breast becomes firmer or visibly changes shape.
• If there is pain, pulling, change in temperature, or redness.
• If a lump, swelling, fluid, sudden asymmetry appears.
• If you feel a "click"/"snap" and the shape changes abruptly (a question of rupture/fluid leakage).

Myths and facts

• " Everyone gets capsular contracture" - no. Everyone gets a capsule (normally), but not everyone gets it painfully tight.
• " Massage prevents contracture" - no reliable evidence.
• " Change implant → end of problem" – not always. If the pocket/technique is not changed or the cause is not addressed, it may recur.
• " A firm breast is just 'firmer'" - no. It's a sign of a complication, not a "perfect shape."

A brief summary

Capsular contracture is a tightening of the tissue around the implant. The cause is a combination of constant foreign stimulus, microbial film, and aging of the materials. The risk increases with age. It is reduced with good surgical technique and appropriate positioning. Treatment ranges from observation and medication (for mild, early cases) to surgery (for severe or recurrent cases). The goal is simple: a soft, painless breast with a natural appearance – not a “hard ball.”

If you want concrete facts about the risks and late complications of implants? Read my book and see what is being left out.

The text is informative and does not replace a medical consultation. The most accurate answer for your case comes from a combination: examination by a plastic surgeon + imaging diagnostics according to indications.

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