I degree
Breasts are soft and look natural - this is what the norm looks like.
CONDITION / BREAST
Capsular contracture of the breast.
Capsular contracture is a tightening of the scar capsule around the breast implant: the breast hardens, changes shape, and may hurt. After breast augmentation, this is the most common reason for repeat surgery. She is treated even when the implants were placed in another clinic.
CONCEPTUAL VISUALIZATION- What it is
- The scar capsule around the implant condenses and compresses it: the breast hardens and changes shape.
- How common
- In FDA postmarketing studies (99,993 patients), severe contracture (grade III–IV) occurred in 7.2% of primary breast augmentations and 12.7% of primary reconstructions.
- degrees
- According to the Baker scale, from I (breasts are soft, natural) to IV (hard, sore, shape changed).
- Who treats it
- A plastic surgeon who performs repeated breast surgeries.
01 / WHAT IS ITWhat is
What is
capsular contracture.
Around any breast implant, the body forms a shell of scar tissue - a capsule. This is a normal reaction of the body to the implant, and the capsule itself does not spoil anything.
Capsular contracture is when the capsule tightens and compresses the implant. Breasts become dense or hard, may hurt and change shape. This happens around one or both implants.
The exact cause of contracture is not known; the risk is likely to increase with time after surgery. For breast augmentation, this is the most common reason for repeat surgery.
Doctors evaluate the contracture according to the Baker scale of four degrees. Grades III and IV are considered severe: that's when a repeat operation may be necessary.
If the implants were placed in another clinic, this is not an obstacle: the doctor evaluates what is available now and makes a plan.
This is general information. The doctor will tell you what will suit you after the examination.
02 / SIGNSHow to recognize
How to recognize
contracture
The degree is determined by the doctor during the examination based on what the breasts feel and look like. Here's what each grade on the Baker scale means.
II degree
Breasts are slightly denser to the touch, but look normal.
III degree
The breasts are dense, and the shape has already changed noticeably.
IV degree
Breasts are hard, painful, the shape is noticeably changed.
One side or both
Contracture can occur around one or both implants, causing the breasts to become asymmetrical.
Displacement of the implant
A compacted capsule can dislodge the implant from where it was placed.
Rupture and displacement of the implant03 / REASONSWhy does it occur?
Why does it occur?
contracture
Presumably, the contracture has several causes at the same time. According to a review of 40 studies, a connection can be traced with some of the factors, for others there is little or no evidence.
Hematoma, infection, seroma
According to the FDA, contracture may occur more often after an infection, a build-up of blood (hematoma) or fluid (seroma) around the implant.
Bacteria and immune response
In a review of 64 studies, the presence of immune cells, macrophages, and the bacteria Staphylococcus epidermidis in the capsules were often associated with contracture. What role this plays is not fully understood.
Implant over the muscle
After breast augmentation, contracture occurred less often when the implant was under the muscle (meta-analysis of 24 studies). After reconstruction, a meta-analysis (16 studies comparing placement) found no difference between supramuscular and submuscular placement.
Irradiation
After radiation therapy, the odds of contracture during implant reconstruction were about 5 times higher (meta-analysis of 15 studies, 5314 patients).
Reconstruction after cancer
Marked contracture occurred more often after primary reconstruction than after breast augmentation: 12.7% versus 7.2% in the FDA data.
time
Implants are not eternal: the longer they stand, the greater the chances of complications, including contracture.
04 / SEEK MEDICAL ADVICE
When to seek medical advice?
Capsular contracture develops gradually, and it usually does not require emergency care - treatment is planned. But if you've recently had breast surgery, including a repeat one, be aware of the signs you shouldn't wait.
103 immediately if:
- it suddenly became difficult to breathe;
- pain in the chest or upper back;
- the heart beats very often;
- the person fainted;
- very frequent breathing;
- confusion or slurred speech;
- bluish, pale or mottled skin;
- very high or very low temperature, chills or shivering;
- a rash that does not go away when pressed.
When to the surgeon:
Immediately - to the surgeon who operated; if it is not possible to contact - to the reception department: after surgery, severe pain or increasing pain; in the first days after the operation, the breasts increase rapidly, become tense and painful. On the same day: to the surgeon who operated, or if this is not possible, to any surgeon, if in the first weeks after the operation there is a burning sensation, unusual swelling of the breast or a change in the color of the skin; the wound is reddened, pus flows from it, the stitches have come apart, or the implant is visible through the skin. Likewise, on the same day, see a doctor (family or in the reception department) if one leg (usually the calf or thigh) hurts and is swollen or you cough up blood: these may be signs of a blood clot. In the coming days: if a year or more after the operation, one breast has noticeably increased, there is a thickening or swelling that does not go away, such a change must be examined. Planned: breasts have gradually become denser, changed their shape or ache - make an appointment for a consultation.
05 / DIAGNOSTICSAs defined,
As defined,
what to treat
- Conversation and documents
When and where the implants were placed, through which incision, above or below the muscle; passport of the implant, if any; whether there was a hematoma, infection, radiation.
- Review
The surgeon evaluates how dense the breasts are, their shape and symmetry, and determines the degree according to the Baker scale.
- ultrasound or MRI
They check whether the implant is intact and whether there is no fluid around it. A rupture of a silicone implant is mostly undetectable, and an MRI is the most accurate way to find it; Ultrasound is an acceptable alternative.
- Plan
What to do with the capsule and implant and whether a new implant is needed is decided together.
06 / TREATMENTHow we treat
How we treat
contracture
Treatment depends on the degree, complaints and wishes. Systematic reviews of controlled studies have not found methods, so the surgeon relies on observations and reviews; the plan is drawn up individually.
01
Without surgery
Mild degrees and medicine.
- I-II degree
- The shape of the breast has not changed. Pronounced III and IV degrees may require repeated surgery; what to do with a lighter one, the doctor will tell during the examination.
- Medicines
- In a meta-analysis of 6 studies (2,276 breasts), among drugs from the group of leukotriene receptor antagonists, only montelukast gave a statistically significant effect, and only in the treatment of already existing contracture; these drugs did not work for prevention. These are prescription drugs — whether they are appropriate for you is up to your doctor.
- Do not knead the capsule with your hands
- A technique in which the capsule is "broken" by forcefully squeezing the breast (closed capsulotomy) is not recommended by the FDA for saline implants: it can cause them to rupture.
02
Surgery
Pronounced contracture, III-IV degree.
- Capsulotomy
- The capsule is dissected to release the implant.
- Capsulectomy
- The capsule is removed partially or completely. The removal of the capsule gives more complications than the removal of the implant itself, so it is done according to indications — in particular, in cases of III-IV degrees, when dissection of the capsule is not enough.
- Implant replacement and new pocket
- According to systematic reviews, replacing the implant and transferring it to another pocket is associated with less frequent return of contracture; data on capsulectomy itself are less conclusive.
- Dermal matrix
- Acellular dermal matrix is placed as a spacer between the implant and the tissues. In a meta-analysis of 9 studies (481 breasts), contracture recurrence after such operations was generally infrequent, but more randomized studies are needed.
- Smooth implants
- The rare BIA-ALCL lymphoma occurs more often in women with textured implants, so the surgeon is limited to smooth implants for repeat operations.
03
Can he come back?
- Yes
- The contracture can recur even after the surgery that corrected it.
- How common
- In one retrospective study (120 patients with implants above the muscle), after complete removal of the capsule, contracture returned in 11% of patients, after removal of only the anterior part — in 50%. But the median follow-up in the first group is 2.5 years, and in the second - 7 years, so these numbers cannot be directly compared.
07 / AT THE VALIKHNOVSKYI INSTITUTE
How
How
we treat it.
Capsular contracture is treated at Dr. Valikhnovskyi's Institute of Surgery in the direction of "Mammary gland reconstruction" - in particular, when implants were placed in another clinic.
CLINIC SERVICE
Breast reconstruction
Breasts after mastectomy - with own tissues, implants or fat, immediately or later.
View service
What we do for this condition
- Capsulotomy — the capsule is dissected, usually through a previous incision; if the implant was placed through the armpit, it can be done endoscopically, under camera control.
- Capsulectomy — the capsule around the implant is removed.
- Implant replacement — the old implant is exchanged for a new one, if necessary, transferred to another pocket.
- Acellular dermal matrices — a frame into which own tissues grow; they are used, in particular, during repeated breast operations after capsular contracture.
- Removal of implants — implants are removed together with the capsule, if necessary, the volume is restored with own fat (lipofilling).
Rostislav Valikhnovskyi
Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovskyi Institute of Surgery.
How treatment works with us
- Photo onlineSend a photo of your breasts, an implant passport or a statement from the clinic where you were operated on.
- ConsultationReview, Baker's degree, talk about complaints and wishes.
- Survey and planUltrasound or MRI of implants; what to do with the capsule and implant and whether a new one is needed.
- SurgeryCapsulotomy or capsulectomy, implant replacement, if necessary — a new pocket or matrix.
- RecoveryA few weeks — supportive underwear and limiting the load on the hands; then — regular control of implants.
08 / QUESTIONS AND ANSWERSCommon
Common
questions
Short answers. What is right for you, the doctor will tell you during the consultation.
Is it possible to be treated at your place if the implants were placed in another clinic?
Yes. The doctor assesses what is now and makes a plan. Take the passport of the implant and the statement from that clinic, if they are available.
Will the contracture go away by itself?
Pronounced contracture of the III-IV degree may require repeated surgery. With a milder degree, the shape of the breast has not changed; what to do, the doctor will tell after the examination.
Can you crush the capsule with your hands?
Not worth it. The method of "breaking" the capsule by squeezing the breast hard is not recommended by the FDA for saline implants because it can cause the implant to rupture.
Can the contracture return after surgery?
Maybe According to reviews, it rarely returns when the implant is changed and transferred to another pocket; there are no controlled studies yet.
Is it possible to simply remove the implants and not put new ones?
You can. But after removal without replacement, the breast may sag, the skin may appear indented or wrinkled. Discuss with your surgeon what is best for you.
The breasts hardened many years after the operation. Is it a contracture?
Maybe, but an examination and ultrasound or MRI are needed. If after a year or more one breast has noticeably increased or a lump has appeared, do not postpone the visit: such a change must be examined.
Does radiation affect contracture?
Yes. After radiation therapy, the odds of contracture with implant reconstruction were approximately 5 times higher in the meta-analysis. At the same time, irradiation remains a necessary part of cancer treatment, and the decision about it is made by the oncologist.
Sources
18 sources · systematic reviews, meta-analyses, FDA, MHRA and NHS datashowCollapse
- US FDA Breast Implant Postapproval Studies: Long-term Outcomes in 99,993 PatientsAnnals of Surgery, 2019doi:10.1097/SLA.0000000000002990 ↗
- Capsular Contracture After Breast Augmentation: A Systematic Review and Meta-AnalysisAesthetic Surgery Journal Open Forum, 2025doi:10.1093/asjof/ojaf003 ↗
- Systematic Review of Capsular Contracture Management following Breast Augmentation: An UpdatePlastic and Reconstructive Surgery, 2024doi:10.1097/PRS.0000000000010358 ↗
- Revisiting the Management of Capsular Contracture in Breast Augmentation: A Systematic ReviewPlastic and Reconstructive Surgery, 2016doi:10.1097/01.prs.0000480095.23356.ae ↗
- Risk factors for developing capsular contracture in women after breast implant surgery: A systematic review of the literatureJournal of Plastic, Reconstructive & Aesthetic Surgery, 2018doi:10.1016/j.bjps.2018.05.022 ↗
- The aetiopathogenesis of capsular contracture: A systematic review of the literatureJournal of Plastic, Reconstructive & Aesthetic Surgery, 2018doi:10.1016/j.bjps.2017.12.002 ↗
- The role of postmastectomy radiation therapy in patients with immediate prosthetic breast reconstruction: A meta-analysisMedicine, 2018doi:10.1097/MD.0000000000009548 ↗
- Capsular contracture in breast reconstruction: A systematic review and meta-analysisJournal of Plastic, Reconstructive & Aesthetic Surgery, 2024doi:10.1016/j.bjps.2024.08.057 ↗
- Efficacy of Acellular Dermal Matrix Type in Treatment of Capsular Contracture in Breast Augmentation: A Systematic Review and Meta-AnalysisAesthetic Surgery Journal, 2023doi:10.1093/asj/sjad265 ↗
- Treatment and Prevention of Periprosthetic Capsular Contracture in Breast Surgery With Prosthesis Using Leukotriene Receptor Antagonists: A Meta-AnalysisAesthetic Surgery Journal, 2022doi:10.1093/asj/sjab355 ↗
- Recurrence of subglandular breast implant capsular contracture: anterior versus total capsulectomyPlastic and Reconstructive Surgery, 2000doi:10.1097/00006534-200009040-00006 ↗
- Capsulectomy Following Breast Implant Removal: Evidence-Based Indications and a Framework for Clinical Decision-MakingAesthetic Plastic Surgery, 2026doi:10.1007/s00266-026-06365-2 ↗
- Risks and Complications of Breast ImplantsFDA, 2023fda.gov/medical-devices/breast-implants/risks-and-complications-breast-implants ↗
- Breast enlargement (implants)NHS, 2023nhs.uk/tests-and-treatments/cosmetic-procedures/cosmetic-surgery/breast-enlargement ↗
- Pulmonary embolismNHS, 2026nhs.uk/conditions/pulmonary-embolism ↗
- DVT (deep vein thrombosis)NHS, 2026nhs.uk/conditions/deep-vein-thrombosis-dvt ↗
- SepsisNHS, 2026nhs.uk/conditions/sepsis ↗
- Breast implant associated anaplastic large cell lymphoma (BIA-ALCL)MHRA, 2025gov.uk/guidance/breast-implants-and-anaplastic-large-cell-lymphoma-alcl ↗
The figures on the page are from these sources.
Breast with an implant
became solid?
Send a photo and a passport of the implant or an extract from the clinic where you were operated on. The doctor will tell you what can be done.