Capsular Contracture: Causes, Grades and Treatment after Breast Implants

Capsular contracture is the most common complication after breast implant surgery. When an implant is placed, the body naturally forms a thin fibrous capsule around it. In some patients, this capsule thickens, hardens and contracts — squeezing the implant and causing firmness, discomfort, distortion or pain.

Baker Classification

Grade	Description
Grade I	Normal — soft, natural-feeling breast, no capsule visible
Grade II	Slightly firm — breast feels firmer than normal but looks normal
Grade III	Moderately firm — visible distortion; breast appears abnormal
Grade IV	Severe — hard, painful, visibly distorted; surgery recommended

Causes and Risk Factors

Subclinical bacterial biofilm (most supported hypothesis)
Haematoma or seroma post-operatively
Smooth implants (higher rate than textured)
Subglandular placement (higher rate than submuscular)
Radiation therapy history
Genetic predisposition

Prevention

No-touch implant technique (14-point plan)
Pocket irrigation with antibiotic/betadine solution
Textured or polyurethane-coated implants (lower contracture rate)
Submuscular or dual-plane placement

Treatment

Closed Capsulotomy

Manual compression to break the capsule — no longer recommended due to risk of rupture.

Open Capsulotomy

Surgical release of the capsule without removing it. Used for Grade II–III.

Total Capsulectomy

Complete removal of the capsule, often combined with implant exchange or removal. Used for Grade III–IV. Can be performed en bloc (capsule + implant removed together).