Capsular Contracture: Part 1

What is capsular contracture?

The formation of a capsule around a breast implant is part of normal wound healing.  The body’s natural response to a foreign object is to form a thin layer of scar tissue around the implant.  However, in capsular contracture, that thin layer of scar tissue becomes thicker and causes a problem in women with breast implants.  There are 4 grades of capsular contracture:

  • Grade 1 – This is the normal response to the breast implant. The capsule is soft and the presence of the capsule is imperceptible to the patient or her plastic surgeon.
  • Grade 2 – There is thickening of the capsule which causes the implant to feel firmer when the breast is examined or manipulated.   However, the presence of the thickened capsule does not change the look of the breast.
  • Grade 3 – The thickening of the capsule becomes worse and the presence of the capsule, in addition to making the breast firm, causes a deformity of the breast that changes the overall look of the breast. The breast mound commonly appears to have moved upward and the implant appears narrowed.
  • Grade 4 – This is the most severe form of capsular contracture. The capsule becomes so thickened that it is visible, palpable and causes the patient pain.

Commonly, once capsular contracture reaches Grade 3 and 4, it is recommended that the patient undergo revision breast surgery to treat the condition.

Dr. Pittman Discusses Capsular Contracture

What causes capsular contracture?

There are a number of theories as to why some patients experience capsular contracture and others do not.  It is likely that the development of capsular contracture is multi-factorial.


Some believe that there is a genetic component.  Patients that form increased scar tissue or have a history of autoimmune inflammatory conditions may be at an increased risk.

Breast Implant Safety

It is important to note that capsular contracture has NOTHING to do with breast implants being unsafe or dangerous.  In all of the 10-year core studies that the FDA required implant manufacturers to complete, the incidence of capsular contracture is about 2% per year.  Therefore at 10-years, there is about a 20% chance that a patient with implants will develop Grade 2-4 capsular contracture.  It is important to note that 75% of capsular contractures occur in the first 2-years after surgery.


There is recent evidence to suggest that capsular contracture can be caused by a “bio-film.”  A bio-film is a thin layer of bacteria that adheres to the implant, causing a low-level inflammatory condition that is not severe enough to cause the patient to feel ill.  However, the chronic presence of the bacteria can cause an inflammatory response that leads to capsular contracture.

Post-Operative Issues

Certain other circumstances such as a post-operative hematoma or seroma can lead to capsular contracture.  It is important to remember that inflammation begets inflammation so any circumstance that induces an inflammatory response can lead to thickening of the capsule.

Stay tuned for part two of this blog to find out what I do to help minimize and prevent capsular contracture.  I will also discuss the various options used to treat Grade 3 and 4 capsular contracture in revision breast surgery.

I would be happy to discuss all of this more with you during your consult.  Please click here to schedule a consult today.

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