Every breast implant forms a capsule around it. That is normal and it is what the body does with any implanted device. Capsular contracture is what happens when that capsule tightens and thickens, squeezing the implant — and it is the most common reason women need further breast implant surgery.
It can appear months or many years after the original operation, and it is one reason implants are better thought of as an ongoing relationship than a single procedure.
How it is graded
| Grade | What it means |
|---|---|
| I | Breast is soft and looks normal. No contracture |
| II | Slightly firm to the touch, but looks normal |
| III | Firm, and the shape has changed — often higher and rounder |
| IV | Firm, distorted and painful |
This is the Baker classification, used internationally. Grades I and II are usually watched. Grades III and IV are the ones that lead to surgery.
What you would notice
- One breast feeling firmer than the other, often the first sign
- The breast riding higher on the chest, or looking rounder and more obviously implanted
- A change in shape you can see in the mirror before you can feel anything
- Discomfort, tightness or pain, particularly at grade IV
- Rippling becoming visible as the implant is squeezed out of shape
A single firm breast that has changed shape is worth having looked at rather than watched indefinitely, because sudden swelling or a mass has other causes that need excluding — see BIA-ALCL and ruptured implant.
Why it happens
The honest answer is that it is not fully understood. The factors discussed in the literature include low-grade bacterial contamination of the implant surface at the time of surgery, bleeding into the pocket, implant surface characteristics, the plane the implant sits in, and radiotherapy. Several of these are the reasons surgeons are careful about how the implant is handled during the operation.
What it is not: it is not caused by anything you did afterwards, and it is not a sign you have looked after yourself badly.
How it is treated
Established contracture does not resolve with massage, tablets or ultrasound. The treatment is surgical, and the operation is chosen to suit the grade and your wishes:
- Capsulectomy with implant exchange. The capsule is removed and a new implant placed, often in a different plane, so the implant sits in fresh tissue.
- Capsulectomy without replacement. The capsule and implant are removed and no new device is placed. See explant surgery.
- Capsulotomy. The capsule is released rather than removed — a smaller operation, and recurrence is more likely.
Recurrence after treatment is possible whichever route is taken, and that should be part of the discussion before you book.
Medicare and capsular contracture
Capsular contracture is one of the clinical indications recognised for item 45551 — removal of a breast prosthesis with excision of at least half of the fibrous capsule, not with insertion of any prosthesis. Where the item is claimed, the capsule must be sent for histopathology.
Removal of an implant as an independent procedure is item 45548. These items cover the surgeon’s fee only, not the hospital, anaesthetist or a new implant.
Common questions
Can massage prevent it? Massage is sometimes advised in early recovery, but there is no good evidence it prevents contracture, and it does not treat established disease.
Will it happen to the other side? Not necessarily. It is often one-sided.
Does it mean something is wrong with the implant? Not usually. The capsule is your tissue, not the device.
If I have it once, will it come back? Recurrence is possible. Removing the capsule and changing the plane is intended to reduce that chance, not eliminate it.
Should I just have them out? That is a legitimate choice and more women are making it. Explant surgery sets out what that involves.
Next step
A breast that has become firm or changed shape should be assessed rather than monitored at home. Bring a GP referral — it is required to see Dr Kumar — and bring your implant cards if you have them. Call 1300 267 726. More about implant removal and revision.
The initial consultation with Dr Kumar is $400, with a Medicare rebate of approximately $88 where you have a GP referral. Surgical fees are quoted individually after your consultation, in a written itemised quote.
All surgery carries risks, and individual results will vary. Read more about the risks of surgery here. A GP referral is required to see Dr Kumar.
Dr Rohit Kumar (MED0001630444) Registered medical practitioner, specialist plastic surgeon (specialist registration in surgery – plastic surgery).
