What is Capsular Contracture?

Capsular contracture is the term used to describe hardening of the breast that can occur as a consequence of implantation of a breast prosthesis. It actually represents shrinkage of the circumferential scar that universally occurs as a normal response to the presence of any foreign body, or in response to injury of tissue. Any wound to the body results in a biological response to that injury that ultimately leads to healing of tissues together by scar. Without scar, injured tissues would never rejoin. When a foreign object, including a medical device such as an artificial joint, a heart valve, or a breast implant is placed within the body, the normal biological response is for scar to be laid down where the prosthesis abuts the host’s tissues.

When it comes to a breast implant, the surface area of this scar must exceed the surface area of the prosthesis for the prosthesis to freely move within the space that is occupies. If the layer of scar that surrounds the implant, which is itself like a bag or rough sphere of scar tissue, were to shrink (like “shrink wrap” on a package) then the implant would be unable to move around within that space. This results in a loss of fluidity of movement, which makes the implant feel hard to the touch. In severe cases, the breasts are distorted and tend to ride up on the chest. It can even become so hard that the breasts ache.

Plastic surgeons have studied this problem from many different perspectives and the exact cause of capsular contracture is unknown. What is known is that it doesn’t improve once is progresses to a particular degree. A classification scheme (known as the Baker Classification) has been proposed that describes different levels of severity of capsular contracture and it goes like this:

Grade I Normally soft and natural
Grade II Firm to the touch, but not apparent without feeling the breast
Grade III Visible distortion of the breast
Grade IV Severe firmness, with distortion and pain

There are no tests that can predict whether a patient is likely to develop capsular contracture. There is currently no known non-surgical treatment, like a pill or physical therapy, which will improve capsular contracture. The treatment involves surgery in which the scar tissue surrounding the prosthesis is removed or scored to open up the space so that the implant can move around. This is sometimes more involved than the original breast implantation surgery, though the recovery is usually much less painful. Unfortunately, this treatment does not guarantee that the problem will not recur.