Your body builds a thin capsule around every breast implant. That happens in everyone and it is entirely normal. What people are really asking when they ask whether an implant hardens over time is what happens if that capsule thickens and tightens, and the name for it is capsular contracture. It is the most common reason a breast implant firms up.
What is capsular contracture, and why does a capsule form around an implant?
That capsule is a defensive response and it has nothing to do with implants specifically. Your body wraps a thin layer of connective tissue around anything foreign we place inside it, and a breast implant is no exception.
The capsule forming isn’t the problem. In some women that tissue thickens and tightens, squeezing the implant inside it. That tightening is what we call capsular contracture. As the capsule contracts, the breast feels firmer, and sometimes the shape changes too.
Why do breast implants harden?
Nobody knows the exact cause. There are two mechanisms we focus on most. The first is a very low level of bacteria reaching the implant pocket during surgery and the biofilm layer they create. The second is that the immune and inflammatory response to an implant varies from person to person. Blood collecting in the pocket after surgery, a hematoma, can set the process off. Genetic predisposition and the characteristics of the implant used also play a part.
The situations that raise the risk are known. In patients whose implant sits over the chest muscle, the risk is higher than it is under the muscle. Having had radiotherapy, or developing an infection or a hematoma after surgery, raises it as well.
What are the symptoms of capsular contracture, and what is the Baker classification?
Symptoms range from mild to severe. What patients notice first is usually the breast gradually getting firmer. Alongside that comes a tight or rounded feeling to the touch, a change in shape, and in more advanced cases, pain. We use the Baker classification to describe how severe the firmness is:
- Baker 1: The breast is soft. It looks natural and feels natural. No contracture.
- Baker 2: The breast is slightly firm but looks normal.
- Baker 3: The firmness is obvious and a visible distortion of the breast shape is starting.
- Baker 4: The breast is hard, painful and clearly distorted.
We follow Baker 1 and 2. Baker 3 and 4 usually need surgery.
How can capsular contracture be prevented?
There is no method that reduces the risk to zero. What we can do is apply everything we know lowers it, throughout the operation. We wash the implant pocket with an antibiotic solution. We place the implant without letting it touch the skin at all, which we call the no-touch technique. In suitable patients we place it under the muscle. Preventing bleeding and infection after surgery is part of the same job, because both of them can trigger a contracture.
How is hardening around a breast implant treated?
We choose the treatment according to how severe the firmness is. In mild cases, Baker 1 and 2, following it is usually enough. Where the firmness and the change in shape are obvious, at Baker 3 and 4, surgery comes onto the table.
We have three routes here. We can release the capsule, which is called a capsulotomy. We can remove part or all of the capsule, a capsulectomy. And if it is needed, we take the implant out and put a new one in. We also talk from the start about the fact that a contracture can come back after surgery.
In a breast where a contracture has already recurred, we don’t repeat the same approach. Changing the plane the implant sits in, removing the whole capsule, or changing the type of implant all come into consideration. The decision depends on what was done at the first operation and on the state of your breast now.
Frequently Asked Questions
Does capsular contracture happen to everyone with implants?
No. A capsule forms in everyone, but that capsule hardening into a contracture happens only in some patients.
When does capsular contracture appear?
There is no set time. It can show up in the first months or years later. That is exactly why we ask you not to skip your check-ups.
My breast has become firm, does that mean I definitely need surgery?
No, not every firmness needs an operation. We follow Baker 1 and 2. The decision to operate is made together, based on how severe the firmness is, whether you have pain and whether the shape has changed.
Is capsular contracture a sign of cancer?
Capsular contracture is a benign tissue reaction. Even so, we want you to tell us about any new firmness or change you notice in your breast, and to come in and be examined.
On the choice of implant, our articles on round or teardrop implants and breast lift or implants are worth a look as well.
Dr. Alper Eskalen assesses capsular contracture and implant hardening in each patient, with all of these details in mind.
