Capsular contracture following breast implant surgery: information on symptoms, risks and treatment after breast augmentation

Capsular fibrosis following breast implant surgery is one of the most common complications after breast augmentation with implants. Although the body naturally forms a soft tissue capsule around each implant, in some cases this capsule can harden and cause discomfort – resulting in capsular fibrosis. This article provides comprehensive information on capsular contracture, explaining what it is, its underlying causes, how it is diagnosed and treated, and the role that insurance covering follow-up costs can play.

Information on capsular fibrosis: What exactly is it?

Capsular fibrosis is a natural reaction of the body to a breast implant, in which a connective-tissue-like sheath (capsule) forms around the implant. This capsule is normally thin, soft and cannot be felt. However, in cases of capsular contracture, there is excessive formation of firm scar tissue. This capsule can thicken, become hardened and contract. Such severe capsular contracture can cause pain, breast deformity and other symptoms following breast augmentation with implants. Capsular contracture is essentially a foreign body reaction.

How does capsular fibrosis develop, and when does it occur?

The exact causes of capsular fibrosis are not always clear, but several factors can lead to its development:

Foreign body reaction/immune reaction: The immune system reacts to the implant as a foreign body. This is a natural immune response.

Bacterial contamination (biofilm): Subclinical bacterial colonisation on the implant surface can trigger a chronic inflammatory response, which contributes to the formation of capsular fibrosis.

Bruises (haematomas) or seromas: Fluid build-up following surgery.

Implant-related factors: Older breast implants with a smooth surface were associated with a higher rate. Modern textured or polyurethane-coated implants appear to reduce the risk of capsular fibrosis. Implant rupture can also contribute to the development of fibrosis.

Surgical technique and implant position: When implants are placed beneath the chest muscle (submuscular), the risk is often lower than when they are placed above the muscle (subglandular).

Irradiation: Radiotherapy to the chest area significantly increases the risk.

Genetic predisposition: An individual tendency towards increased formation of connective tissue.

Capsular fibrosis sometimes only develops years after breast implants have been inserted.

Symptoms of capsular fibrosis: recognising the signs

The symptoms of capsular fibrosis may develop gradually or appear suddenly. Typical signs of capsular fibrosis vary depending on the severity:

Tension and stiffness: The breast feels firm or even hard; a slight lump may be an early symptom. You may also experience a feeling of tightness in your breast. Any such lumps in your breast should be investigated by a doctor.

Pain: Ranging from mild discomfort to painful capsular fibrosis, which worsens with certain movements.

Changes in the shape of the breast: The breast may appear unnaturally round, spherical or misshapen; this leads to deformation. The breast may feel or look misshapen.

Displacement or elevation of the implant: The implant may change or shift position.

Palpability of the implant: The edges of the implant may be more noticeable.

Breast asymmetry: If the breast is misshapen or only one side is affected.

If such symptoms occur, a specialist should be consulted immediately to investigate the possibility of capsular fibrosis.

Diagnosis and stages (Baker): Is capsular fibrosis dangerous?

Capsular fibrosis is primarily diagnosed through a clinical examination. In addition, imaging techniques such as ultrasound (sonography) may be used. The question „Is capsular fibrosis dangerous?“ can usually be answered with a ‘no’, but it can be very distressing and may affect quality of life due to pain and breast deformity.

The Baker scale (often divided into four grades) is used internationally to classify the severity of capsular fibrosis:

Degree (Baker)	Description	Typical symptoms & signs
Grade I (Baker 1)	The implant is soft; the breast feels natural; there is no hardening	No discomfort, normal breast shape. This is to be expected following breast augmentation.
Grade II	Minimal hardening; the breast is slightly firm	The implant may be palpable, but there is no obvious change in shape and, in most cases, no pain. There is mild capsular fibrosis.
Grade III (Grade 3)	Moderate to marked thickening of the capsule	The breast is firm; a change in shape is often visible (deformation of the breast), and there may be mild pain. Pronounced capsular fibrosis.
Grade IV (Baker 4)	Severe induration, contraction of the capsule. The capsule is severely indurated.	The breast is hard and severely deformed (distortion), often accompanied by significant pain. Severe capsular fibrosis.

The formation of a connective-tissue-like capsule is normal to a certain extent; it becomes problematic at grades III and IV.

How is capsular fibrosis treated? Surgery & implant replacement

Treatment depends on the severity of the capsular fibrosis and the symptoms present. Not all cases of capsular fibrosis can be treated in the same way:

Conservative measures: In cases of mild capsular fibrosis (often Baker Grade II), massage may be tried, although its effectiveness is limited.

Surgical treatment: Surgery is usually required when capsular fibrosis needs to be treated, particularly in cases of Baker Grade III and Grade IV.

Capsulotomy: An incision is made in the capsule (rarely).

Partial or total capsulotomy: The hardened capsule is removed either partially or completely.

Implant replacement: The implant is often removed or replaced – possibly with a different model – or its position corrected (e.g. placement beneath the chest muscle). Implant replacement is a common procedure during surgery to treat capsular contracture.

The choice of treatment for capsular contracture is discussed on a case-by-case basis. There is no one-size-fits-all solution for treating capsular fibrosis. Breast augmentation using the patient’s own fat is an alternative to breast implants and carries no risk of implant-associated capsular fibrosis, as no foreign body (implant) is used.

Preventing capsular fibrosis: Minimising the risk of capsular fibrosis

There is no 100 per cent guarantee that capsular fibrosis can be prevented. However, various measures can help to minimise the risk of capsular fibrosis, particularly the risk of it recurring:

Choosing an experienced surgeon: Important for minimally invasive surgical techniques.

Implant selection and positioning: Modern breast implants (e.g. those with a textured surface or a polyurethane coating) and placement beneath the chest muscle (submuscular placement of the implants) can reduce the risk.

Minimising bacterial contamination: Strict hygiene measures during the operation.

Aftercare: Follow your doctor’s instructions.

Giving up smoking: Smoking can interfere with wound healing.

These measures can help to prevent capsular fibrosis from developing. It is important to obtain comprehensive information about capsular fibrosis and ways of preventing it before undergoing breast augmentation surgery.

Capsular fibrosis and the role of insurance covering subsequent costs

Capsular contracture, particularly in the more severe Baker grades III or IV, often makes a repeat operation medically necessary. The costs of such a procedure (e.g. implant replacement or removal of the capsule) are usually not covered by standard health insurance policies, as the original breast augmentation with implants was generally considered a cosmetic procedure.

A special Consequential Costs Insurance offer important financial protection. These are designed to cover the costs of medically necessary follow-up operations following cosmetic procedures – such as in the case of severe capsular contracture following breast implant surgery. It is advisable to find out more about this before undergoing breast augmentation surgery.

FAQ: Can capsular fibrosis be prevented? & other questions