Capsular Contracture

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Once a breast implant is in place, fibrous scar tissue forms around it, creating a tissue capsule. The body forms a protective capsule like this around any object it recognizes as foreign. The tissue capsule is usually soft or slightly firm, not noticeable, and helps to keep the implant in place. In some women, a tissue capsule forms that is unusually hard and dense. The capsule tightens around and squeezes the implant. This condition, called capsular contracture, can cause chronic pain and distortion in the shape of the breast, and it can make the breast rise higher on the chest.

Who is at risk of capsular contracture?

If you’ve had radiation therapy at any time in the past — and particularly if you had it after your initial breast reconstruction surgery — that can greatly increase your risk of developing capsular contracture. But overall, the reasons that some individuals develop capsular contracture while others do not are not well understood.

Some of the other factors that may raise the risk of capsular contracture include rupture of an implant, hematoma (a build-up of blood where tissue was removed during surgery), developing a microbial biofilm (subclinical infection) on an implant, and a genetic predisposition to forming scars.

Signs and symptoms of capsular contracture

Signs of capsular contracture, such as increasing firmness or tightness in the breast, can start to appear as early as a few months after your implant reconstruction surgery or years later.

You may want to consider corrective surgery for capsular contracture if it’s causing you chronic pain, restricted range of motion, and/or changes in the position and shape of the breast.

Corrective surgery options for capsular contracture

Some of the options for correcting capsular contracture include:

  • Capsulectomy: During a capsulectomy, your surgeon will remove the existing implant and the surrounding tissue capsule and insert a new implant that is wrapped in a sheet of dermal matrix material (a skin substitute made mostly of collagen). The dermal matrix material provides an extra protective layer, and the body will form a new capsule of scar tissue around it.
  • Open capsulotomy: During an open capsulotomy, your plastic surgeon will attempt to cut open the tissue capsule around the implant by making small incisions and may also remove some of the capsule. The goal is for the capsule to pop open, giving the implant more room to move around. In some cases, your surgeon will also remove your existing implant and replace it with a new one.
  • Autologous reconstruction: During an autologous reconstruction, your plastic surgeon will remove your implant and reconstruct your breast with a flap of tissue transplanted from another area of your body, such as your belly or buttocks. An important advantage to this approach is that it eliminates the risk that capsular contracture will recur, as a tissue capsule will not form around a flap. However, autologous reconstruction is a more complex surgery with a longer recovery time than a capsulectomy or open capsulotomy. Learn more about autologous reconstruction.
Capsular Contracture 1 - Corrective Breast Reconstruction
Left image: Capsular contracture developed in the right breast and the left implant moved into a position that was too low on the chest after a bilateral mastectomy and silicone implant reconstruction.
Right image: The capsular contracture on the right breast was corrected by removing the implant and reconstructing the breast with "stacked" DIEP flap surgery. The displacement of the left implant was corrected by removing the implant, inserting a new implant, and making adjustments to the pocket of tissue that holds the implant in place.
Capsular Contracture 2 - Corrective Breast Reconstruction
Left image: Capsular contracture developed in the left breast and chronic discomfort developed in both breasts after a bilateral mastectomy and implant reconstruction.
Right image: Corrective surgery involved removing both implants and the capsule of scar tissue surrounding each implant and reconstructing the breasts using the DIEP flap procedure.
Capsular Contracture 3 - Corrective Breast Reconstruction
Left image: Capsular contracture developed in the right breast after a mastectomy and implant reconstruction.
Right image: Corrective surgery involved removing the implant and the capsule of scar tissue surrounding the implant and reconstructing the breast using the “stacked" DIEP flap procedure.

The photographs on this page are copyrighted materials and no reproduction or use of these photographs is permitted except with the written consent of the Center for Restorative Breast Surgery.

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