Medically reviewed content from Don R. Revis, Jr., MD, FACS, double board-certified plastic surgeon

Every breast implant, no matter how well it’s placed, sits inside a capsule of scar tissue that the body naturally forms around it — this is a normal part of healing. Capsular contracture happens when that capsule becomes abnormally thick or tight, and it’s one of the most frequently cited reasons patients return for revision surgery. Here’s what it is, how it’s classified, and what treatment actually involves.

What Is Capsular Contracture?

Capsular contracture is the abnormal thickening and tightening of the scar tissue capsule that forms around a breast implant. In mild cases, it has little to no effect on how the breast looks or feels. In more advanced cases, the tightened capsule can distort the shape of the breast, make it feel unnaturally firm, and in some cases cause real discomfort or pain.

What Causes Capsular Contracture?

The exact mechanism isn’t fully understood in every case, but the condition is more frequently seen following complications such as infection or hematoma (a collection of blood) around the implant in the period after surgery. Implant placement also appears to play a role — implants placed in a totally submuscular position are generally associated with a lower rate of capsular contracture than implants placed above the muscle.

The Baker Grading Scale

Plastic surgeons classify capsular contracture using the Baker Grade scale, a four-point system that describes severity:

Grade	Feel & Appearance	What It Means
I	Soft, natural	Breast looks and feels just like a normal, unoperated breast
II	Slightly firm	Implant can be felt, but the breast still looks normal
III	Firm, abnormal-looking	Implant is easily felt and visibly distorts the breast’s shape
IV	Hard, often painful	Breast is hard, visibly abnormal, and frequently uncomfortable or painful

Grades I and II are typically monitored rather than treated surgically. Grades III and IV are where most patients begin considering — or are advised to pursue — surgical correction.

Can Capsular Contracture Be Prevented?

There’s no guaranteed way to prevent it, but a few factors are associated with lower rates: submuscular implant placement, meticulous surgical technique that minimizes bleeding and bacterial contamination during the original procedure, and prompt treatment of any post-operative infection or hematoma should one occur.

Treatment Options

Capsulectomy

A capsulectomy is the complete removal of the scar tissue capsule surrounding the implant. This is generally considered the definitive treatment for capsular contracture, particularly at Grade III or IV. It’s often combined with repositioning the implant to a totally submuscular position, which can reduce the likelihood of the contracture recurring.

Capsulotomy

A capsulotomy is an incision made in the capsule rather than its full removal. On its own, this is not considered an effective treatment for capsular contracture — it doesn’t address the underlying scar tissue. It is, however, a useful technique when the goal is adjusting the size or shape of the implant pocket for other reasons.

Implant Placement Change

For patients whose implants were originally placed above the muscle, moving to a totally submuscular position at the time of revision is often recommended, since it’s associated with a lower recurrence rate going forward. This is frequently addressed as part of broader breast augmentation revision surgery.

Recovery After Capsular Contracture Surgery

Recovery generally mirrors a standard revision procedure: most patients take a few days for the initial swelling and discomfort to settle, resume non-strenuous activities within about a week, and return to full exercise within three to six weeks, depending on the extent of the surgery and individual healing.

Frequently Asked Questions

How common is capsular contracture?

Rates vary across studies and by implant placement and type, but it’s consistently cited as one of the most common reasons patients pursue revision surgery, alongside implant malposition and size changes.

Does capsular contracture mean something is wrong with my implant?

Not necessarily. It’s a reaction in the surrounding scar tissue, not typically a defect in the implant itself, though implant type and placement can influence risk.

Is capsular contracture painful?

It can be, particularly at Grade IV, where the tightened capsule can cause genuine discomfort. Grades I and II are usually not painful.

Will capsular contracture come back after treatment?

It can recur, which is part of why many surgeons recommend combining capsulectomy with a change to submuscular placement — this combination is associated with lower recurrence than capsulectomy alone.

How do I know if my firmness is capsular contracture or just normal healing?

Some firmness in the weeks after surgery is normal. Firmness that develops months or years later, or that’s accompanied by visible distortion or discomfort, warrants an evaluation.

If your implants have become firmer or changed shape over time, schedule a consultation to determine your Baker grade and discuss whether treatment is recommended.