Capsular contracture is when the scar tissue capsule that naturally forms around a breast implant thickens and tightens, squeezing the implant so the breast feels firm, looks rounder or sits higher on the chest. It is one of the most common reasons people need revision surgery after breast augmentation. It can be treated. And it is not cancer.
Maybe you already have implants and something feels different. Or you are researching breast augmentation and want to understand the risks before you decide. Either way, this guide covers the early signs, the Baker grading scale surgeons use, what is thought to cause capsular contracture, and the treatment options a Specialist Plastic Surgeon may discuss with you.
What is capsular contracture?
Capsular contracture is an abnormal tightening of the scar tissue around a breast implant. Every implant develops a capsule. That part is normal and expected; the problem only starts when the capsule thickens and contracts.
Why the body forms a capsule around a breast implant
Your body recognises an implant as a foreign object, meaning something it did not make itself. It responds by walling the implant off with a thin layer of collagen-rich scar tissue called the capsule. In most people this lining stays soft and thin, and it actually helps hold the implant in place.
Normal capsule versus contracted capsule
| Normal capsule | Contracted capsule |
|---|---|
| Thin and flexible | Thickened and tight |
| Breast feels soft | Breast feels firm or hard |
| Implant moves naturally | Movement is reduced |
| Breast shape looks natural | Breast looks rounder or sits higher |
| Usually no discomfort | Tightness, pressure or aching may develop |
What are the first signs of capsular contracture?
The first signs of capsular contracture are usually a breast that feels firmer than before and an implant that seems to sit higher or look rounder. Pain tends to come later, if it comes at all.
Patients often notice changes in roughly this order:
- The breast feels firmer than it used to, often on one side only.
- The implant looks like it is riding higher on the chest.
- The breast looks rounder, sometimes described as ball-like.
- The breast moves less naturally when you lie down or change position.
- One breast looks different from the other (asymmetry) or appears distorted.
- You feel tightness or a squeezing sensation.
- Pain or aching develops, which is usually a later sign.
Capsular contracture most often appears within the first year after surgery, and the risk keeps rising over time. So an implant that has been soft and stable for years can still change.
What capsular contracture pain feels like
Capsular contracture pain usually feels like tightness, pressure or a squeezing ache rather than a sharp pain. Some women notice it more when lying on that side, during exercise or in a firm bra. The discomfort tends to build as the contracture progresses.
When to contact your surgeon
Contact your surgeon if you notice any change in the firmness, shape or comfort of a breast with an implant. An early review gives you more information and, often, more options. NSW Health recommends that people with breast implants check their breasts regularly and see their GP or surgeon for a clinical review every 12 months.
The Baker grading scale explained (Grades I to IV)
The Baker grading scale is the system surgeons use to describe how severe capsular contracture is. It runs from Grade I (normal) to Grade IV (firm, distorted and painful).
| Grade | What the patient notices | What the surgeon finds on examination | Usual approach |
|---|---|---|---|
| Grade I | Breast feels soft and looks normal | Soft capsule | No treatment needed |
| Grade II | Breast slightly firm, looks normal | Mild firmness, implant can be felt | Usually monitored |
| Grade III | Breast firm and looks abnormal | Firm capsule, implant distorted or riding high | Surgery usually discussed |
| Grade IV | Breast hard, distorted and painful | Hard capsule, marked distortion, tenderness | Surgery usually recommended |
Your surgeon assigns the grade during a physical examination. It is not something you can reliably score at home, because other problems, such as implant rupture, can look and feel similar.
What causes capsular contracture?
The exact cause of capsular contracture is not fully established. The leading explanation is a low-grade bacterial film (biofilm) on the implant surface, which is thought to trigger an exaggerated scar response.
Most experts describe capsular contracture as having several contributing causes. A 2021 review in Seminars in Plastic Surgery notes that surgeons agree the process is inflammatory, but still debate what sets it off, which makes it hard to predict who will be affected. Factors that have been associated with a higher risk include:
- a collection of blood (haematoma) or fluid (seroma) around the implant after surgery
- infection
- radiotherapy to the breast
- implant surface texture
- implant position relative to the chest muscle
- smoking
- a previous episode of capsular contracture
None of these explains every case, and some people develop contracture without any of them. Implant texture is a good example of how complicated the picture is. Textured surfaces have been studied as a way to lower contracture rates, but some textured implants have also been linked with BIA-ALCL, a rare lymphoma. In 2019, the TGA recalled and suspended a number of breast implants and tissue expanders in Australia.
Does implant placement above or below the muscle change the risk?
Some studies suggest implants placed under the muscle (submuscular or dual plane) have lower contracture rates than implants placed on top of it (subglandular). A 2015 review identified subglandular placement, rather than submuscular, as one of several risk factors. Still, placement is only one piece of the puzzle. The right pocket depends on your anatomy, your tissue thickness and your goals, which is covered in our guide on how to choose the right breast implant shape and size.
How is capsular contracture diagnosed?
Capsular contracture is diagnosed mainly through a clinical examination. Your surgeon looks at and feels both breasts, then assigns a Baker grade.
Imaging such as ultrasound or MRI may also be arranged. This is usually not to confirm the contracture itself. It is mostly to check for implant rupture, which can cause similar changes in shape and firmness.
How capsular contracture differs from BIA-ALCL
Capsular contracture is a different condition from breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), a rare cancer of the immune system. BIA-ALCL most often shows up as swelling caused by fluid around the implant (a late seroma), usually years after surgery, and sometimes as a lump. Contracture, by contrast, causes gradual firmness and tightening. The TGA advises anyone with breast implants who notices swelling, a lump or pain in the breast or armpit to see their doctor. Dr Cope has spoken publicly about breast implant recalls and BIA-ALCL, and you can find that material on our news page.
How is capsular contracture treated?
Established capsular contracture is corrected with surgery. There is no reliable non-surgical fix once the capsule has contracted. The operation recommended depends on your Baker grade, your implant and its position, your breast tissue, and whether you want implants in the future. Surgery for capsular contracture is a type of breast augmentation revision.
Capsulectomy (removing the capsule)
A capsulectomy removes the scar tissue capsule. A partial capsulectomy removes part of it, while a total capsulectomy removes all of it. You may also hear the term “en bloc”, which means the implant and the whole capsule are taken out together in one piece without opening the capsule. En bloc removal is not always possible or needed. It depends partly on how firmly the capsule is attached to the ribs and chest wall.
Capsulotomy (releasing the capsule)
A capsulotomy releases the capsule through incisions (an open capsulotomy) to give the implant more room, without removing the tissue. It may suit some milder cases. It is used less often than capsulectomy because the contracted tissue stays behind. The older “closed capsulotomy”, where the breast was squeezed firmly from the outside to break the capsule, is no longer recommended because it can rupture the implant.
Implant exchange and changing the pocket
The implant is often replaced during the same operation. Your surgeon may also suggest a new pocket, such as moving from above the muscle (subglandular) to below it (submuscular or dual plane), to give the new implant a fresh space.
Removal without replacement (explant)
Some women decide they no longer want implants. In that case, the implants and capsules are removed and not replaced, and in some cases a breast lift may be discussed at the same time. You can read more about breast implant removal.
What about non-surgical options?
Massage, ultrasound therapy and leukotriene inhibitors (a type of asthma medicine, used off-label) have all been trialled. A few small studies report some softening in early or mild cases, but the evidence for reversing established contracture is limited. Grade I and mild Grade II contracture is often monitored rather than treated.
How the risk of capsular contracture is reduced during surgery
No technique can prevent capsular contracture completely. What a surgeon can do is use measures that aim to reduce the risk, such as:
- a “no-touch” technique, sometimes with an insertion sleeve (funnel), to limit contact between the implant and the skin
- rinsing the implant pocket with antiseptic or antibiotic solution (pocket irrigation)
- careful control of bleeding to lower the chance of haematoma
- handling the implant as little as possible
- precise dissection of the pocket so the implant sits in a well-defined space
- choosing an implant and pocket suited to your tissues
- antibiotics around the time of surgery
Your part matters too. Not smoking, going to your follow-up appointments and reporting changes early all help. Dr Cope can explain his own approach during your consultation.
Can capsular contracture come back after revision surgery?
Yes, capsular contracture can come back after revision surgery, and the risk is higher than after a first-time breast augmentation. That is why revision surgery usually involves more than swapping the implant. Depending on your situation, it may include removing the old capsule, creating a new pocket, using a new implant and repeating the same risk-reduction steps used in a primary operation. Your surgeon should talk you through your individual risk before you decide.
Risks of revision surgery
All surgery carries risk, and revision breast surgery is no different. Possible risks include bleeding, infection, changes in nipple or breast sensation, asymmetry, implant malposition, scarring, anaesthetic risks and recurrent contracture. You can read more about surgery risks and complications.
When to see a Specialist Plastic Surgeon
See a Specialist Plastic Surgeon if a breast with an implant changes in firmness, shape, position or comfort. A change in an implant that has been stable for years always deserves an assessment.
Book a review if you notice:
- one breast becoming firmer or rounder than the other
- an implant that seems to be moving upwards
- tightness, aching or pain
- new swelling, a lump or a change in the armpit
- that it has been more than 12 months since your last implant check
Dr Cope consults in Mosman on Sydney’s Lower North Shore, in Wahroonga on the Upper North Shore, and in Gosford on the Central Coast. A referral from your GP is required, and a mandatory cooling-off period applies before cosmetic surgery in Australia.
Why choose Dr Cope for capsular contracture treatment and breast implant revision in Sydney, North Shore (Mosman & Wahroonga) and Central Coast (Gosford)
Dr Charles Cope is a Specialist Plastic Surgeon who takes an ethical, patient-focused approach to care. His AHPRA registration number is MED0001146826, which you can check on the public register.
- Specialist Plastic Surgeon, AHPRA registration MED0001146826
- Fellow of the Royal Australasian College of Surgeons (FRACS)
- Member of the Australian Society of Plastic Surgeons (ASPS)
- Member of the Australian Society of Aesthetic Plastic Surgeons (ASAPS)
- International member of the American Society of Plastic Surgeons
Specialist Plastic Surgeons are the only specialty accredited by the Australian Medical Council (AMC) to perform cosmetic surgery (as well as reconstructive plastic surgery).
Dr Cope offers breast augmentation revision and breast implant removal, including the assessment and surgical treatment of capsular contracture, and he has spoken publicly about breast implant recalls and BIA-ALCL. A capsular contracture consultation includes an examination, Baker grading, a review of your implant history and a discussion of every option, including removal without replacement.
Patients from across Sydney, the North Shore (Mosman and Wahroonga) and Gosford on the Central Coast can see Dr Cope at three locations. He is also listed as a specialist with Sydney Adventist Hospital and Ramsay Health Care.
- Mosman: Level 1, 357 Military Rd, Mosman, Sydney NSW 2088 (Lower North Shore)
- Wahroonga: Suite 507, SAN Clinic, 185 Fox Valley Rd, Wahroonga, Sydney NSW 2076 (Upper North Shore)
- Gosford: 3 Hills St, Gosford NSW 2250 (Central Coast)
Verify Dr Cope’s credentials:
- Australian Society of Plastic Surgeons profile
- Australian Society of Aesthetic Plastic Surgeons profile
- Board Certified profile
- healthdirect listing: Mosman
- healthdirect listing: Gosford
- Sydney Adventist Hospital profile
- Ramsay Health Care profile
- RealSelf profile
To arrange an assessment, call (02) 9307 2888 or book a consultation online. A GP referral is required. All surgery carries risk; please read about surgery risks and complications before making a decision.
Frequently asked questions about capsular contracture
What are the first signs of capsular contracture?
The first signs of capsular contracture are a breast that feels firmer than it used to, an implant that looks higher or rounder, and a tight or squeezing sensation. Pain is a later sign, not an early one. Most cases appear within 12 months of breast augmentation, but capsular contracture can develop years later.
Is capsular contracture dangerous?
No, capsular contracture is not life-threatening and it is not a form of cancer. It is a complication of breast implant surgery that affects the comfort, firmness and appearance of the breast. Baker Grade III and Grade IV capsular contracture is usually treated with surgery because the breast is visibly distorted, firm or painful.
Can capsular contracture be fixed without surgery?
No. Once the capsule has thickened and contracted, surgery is the only reliable way to correct capsular contracture. Massage, medication and ultrasound have been trialled, but evidence for reversing established contracture is limited. Baker Grade I and mild Grade II capsular contracture is often monitored rather than treated.
How common is capsular contracture after breast augmentation?
Capsular contracture affects around 1 in 10 people with breast implants; a 2015 review reported an overall incidence of 10.6%. Risk varies with implant type, pocket position, radiotherapy and time since surgery. Australian Breast Device Registry data showed capsular contracture in 41 of every 100 people having breast implant revision surgery in 2018.
Does Medicare cover surgery for capsular contracture?
Medicare may cover part of the cost of capsular contracture surgery in Australia when MBS criteria are met. MBS item 45551 covers breast implant removal with excision of at least half the capsule, without a new implant, when there is a medical reason such as capsular contracture. Replacement items 45553 and 45554 have stricter criteria and are not payable when surgery is done only to increase breast size.
If you have noticed a change in your implants, you are welcome to book a consultation with Dr Cope in Mosman, Wahroonga or Gosford.
Further reading
- Breast Augmentation Revision
- Breast Implant Removal
- How To Choose The Right Breast Implant Shape And Size For Me
- When Can I Start Exercising After Breast Augmentation Surgery?
Medical references
- Therapeutic Goods Administration (TGA). Breast implant hub
- TGA. Breast implants and anaplastic large cell lymphoma
- healthdirect Australia. Breast augmentation (breast implants)
- NSW Health. Information for people with breast implants (fact sheet)
- Monash University. Australian Breast Device Registry
- Australian Government Department of Health. MBS Online: Item 45551 and Item 45553
- American Society of Plastic Surgeons. What is capsular contracture and how can it be treated?
- Cleveland Clinic. Breast implant removal
- Safran T, et al. Current Concepts in Capsular Contracture: Pathophysiology, Prevention, and Management. Semin Plast Surg. 2021;35(3):189-197. doi:10.1055/s-0041-1731793
- Headon H, Kasem A, Mokbel K. Capsular Contracture after Breast Augmentation: An Update for Clinical Practice. Arch Plast Surg. 2015;42(5):532-543. PubMed
Disclaimer
The information in this article is general in nature and is not a substitute for personalised medical advice. It does not replace a consultation with a qualified medical practitioner. Every patient is different, and the suitability, risks and outcomes of any procedure can only be assessed during an in-person consultation with a Specialist Plastic Surgeon. All surgical and invasive procedures carry risks; please read about surgery risks and complications before making a decision. Before proceeding, you may wish to seek a second opinion from another appropriately qualified health practitioner. A GP referral is required for consultation. Information was current at the time of publication (September 2026), and Medicare item details are subject to change; check MBS Online for current details.
