Capsular contracture

The decision to have breast implants has been made, the operation went well, but months or even years later, the breast suddenly changes. They feel firmer, become misshapen or are painful. These symptoms often indicate the most common long-term complication following breast augmentation or breast reconstruction: capsular contracture (usually referred to as capsular fibrosis in German-speaking countries).

For many patients, this diagnosis comes as a shock at first. However, it is important to know that this is a natural, albeit excessive, reaction by the body, which can be effectively treated using modern plastic surgery techniques. In this guide, we explain how capsular contracture develops, how you can assess the symptoms yourself using the Baker scale, and what treatment options are available.

What is capsular contracture?

Capsular contracture (or capsular fibrosis) is a pathological hardening and tightening of the connective tissue sheath (capsule) that the body naturally forms around every breast implant. Whilst a soft capsule is a normal and desirable reaction to the foreign body, in the case of contracture the tissue thickens excessively, contracts and exerts strong pressure on the implant. This leads to palpable hardening, visible deformities of the breast and, in severe cases, pain.

Causes: Why do breasts become firm?

The exact reasons why the immune system overreacts in some women but not in others remain the subject of medical research to this day. However, there are known risk factors that increase the likelihood of capsular contracture developing:

• Subclinical infections (biofilm): Bacteria (e.g. staphylococci) that come into contact with the implant in minute quantities during surgery can form what is known as a biofilm. This causes chronic irritation of the tissue and triggers capsule formation.
• Haematomas and seromas: Post-operative bruising or the accumulation of serous fluid in the implant pocket increases the risk of an inflammatory reaction.
• Implant position and surface: Implants placed above the chest muscle (subglandular) are statistically associated with a higher risk than those placed beneath the muscle (submuscular/dual-plane). Smooth surfaces are also more prone to capsular contracture than lightly textured ones.
• Radiotherapy: Following breast cancer and radiotherapy, the risk of capsular contracture is significantly increased in cases of implant-based reconstruction.

The Baker Scale: Identifying severity levels and symptoms

In medicine, capsular contracture is classified into four degrees of severity according to the American surgeon John L. Baker. This scale helps doctors and patients to assess the findings objectively.

Treatment options: From massage to surgery

Treatment is always determined by the Baker grade and the individual’s level of distress.

Conservative methods (Baker I and II)

In the early, mild stages where there is no pain, doctors often advise a ‘wait-and-see’ approach. Special breast massages, ultrasound therapy or medication (e.g. anti-inflammatories) may be used as supportive measures to prevent the condition from progressing.

Surgical methods (Baker III and IV)

In cases of severe capsular fibrosis, surgery is essential to relieve the pain and restore the appearance. There are primarily two surgical procedures:

• Capsulotomy (incision of the capsule): The hardened capsule is surgically incised so that it expands and makes room for the implant again. This procedure is used less frequently nowadays due to high recurrence rates.
• Capsulotomy (removal of the capsule): The standard procedure. The hardened connective tissue capsule, together with the old implant, is removed from the body either completely or partially. A new implant is then usually inserted, ideally into a new tissue plane (e.g. changing from above the muscle to below the muscle), in order to minimise the risk of fibrosis recurring.

Prevention: Can capsular contracture be prevented?

It is not possible to guarantee that the implant will heal without capsular fibrosis. However, modern surgical techniques (such as the „no-touch technique“ using insertion aids/Keller funnels to prevent contact with bacteria) and careful aftercare (post-operative care) by the patient now reduce the risk to less than 5 per cent.

Financial protection: Who pays for capsular fibrosis?

Further information on covered procedures can be found on the Overview page on treatments and procedures as well as in the Frequently Asked Questions.

Frequently Asked Questions (FAQ)