Breast implants are a common cosmetic surgery procedure to enhance breast size and shape. However, like any implanted medical device, breast implants do carry some risks. One potential complication that can occur over time is capsular contracture, which is when scar tissue forms around the implant, creating a “capsule” that can tighten and squeeze the implant. This can cause pain, distorted breast shape, and firmness. So how do you know if your breast implant has become encapsulated?
What is capsular contracture?
Capsular contracture occurs when the body forms scar tissue around the breast implant as a natural response to a foreign object. This scar tissue forms a capsule that surrounds and encloses the implant. In some cases, the capsule tightens and squeezes the implant, which can make the breast feel firm or misshapen.
Capsular contracture is classified into 4 grades:
- Grade I – the breast feels and looks normal
- Grade II – the breast is a little firm but looks normal
- Grade III – the breast is firm and looks abnormal
- Grade IV – the breast is hard, painful, and looks very abnormal
Higher grades indicate tighter squeezing and distortion of the implant from significant capsular contracture. Grade III and IV encapsulation typically require surgery to treat.
What causes capsular contracture?
The exact cause of capsular contracture is not fully understood. Factors that may increase the risk include:
- Bacterial contamination during surgery
- Implant rupture
- Hematoma or seroma around the implant
- Use of textured implant surfaces rather than smooth
- Radiation therapy
- Build up of calcium deposits around the implant
Genetics may also play a role, as some women seem predisposed to developing tighter capsules around implants.
Signs your breast implant is encapsulated
Signs that your breast implant may be encapsulated include:
- Changes in breast shape – Your breast appears distorted or misshapen, often described as “rounded.” The implant is felt as a discrete, firm lump.
- Firmness and hardening – Your breast feels abnormally firm or hard to the touch.
- Pain or tenderness – You experience breast pain and tenderness, especially when pressing on the implant.
- Rippling or wrinkling – You notice visible rippling or wrinkling of the skin over the implant.
- High-riding implant – The implant appears to be riding too high on the chest wall.
- Skin rash – A persistent, itchy rash develops on the breast skin over the implant.
If you notice any of these signs, see your plastic surgeon for an exam. Imaging tests like an ultrasound or MRI can also help diagnose encapsulation and assess its severity.
How is encapsulation diagnosed?
To diagnose breast implant encapsulation, your doctor will:
- Perform a physical exam to look for breast firmness, tenderness, and changes in shape/appearance.
- Palpate the implant edges and surrounding breast tissue.
- Assess the degree of capsular contracture using the 4-grade scale.
- Order tests like ultrasound, MRI, or mammogram to visualize the breast capsule and look for rupture.
- Review your symptoms and medical history.
Your doctor may also order bloodwork or cultures if infection is suspected. In uncomplicated cases, diagnosis can often be made by exam alone. Imaging and other tests help if the diagnosis is uncertain or to plan treatment.
Imaging tests
Some key imaging tests used to evaluate potential breast implant encapsulation include:
| Test | What it shows |
|---|---|
| Ultrasound | Capsule thickness, tightness, and integrity. Checks for fluid buildup or rupture. |
| MRI | Capsule appearance, implant pocket, implant integrity. Best for assessing severity. |
| Mammogram | Useful if capsule calcifies. Less optimal than ultrasound or MRI. |
These tests are not needed for mild cases, but help plan treatment for higher grades of encapsulation.
Risk factors for capsular contracture
Factors that increase the risk of developing significant capsular contracture include:
- Textured implant surface – More friction may cause greater scar tissue formation.
- Subglandular placement – Increased risk versus submuscular placement.
- Prior capsule formation – Increased risk with capsule from previous implant.
- Infection – Contributes to inflammatory capsule tightening.
- Hematoma/seroma – Fluid accumulations can promote contracture.
- Radiation therapy – Radiation scars breast tissue including capsules.
- Smoking
- Genetic predisposition – Some women form thicker capsules.
Talk to your surgeon about your individual risk profile before having implants placed. Follow post-op care instructions carefully to lower encapsulation risks.
Can capsular contracture resolve without surgery?
In mild cases of capsular contracture (Grades I-II), non-surgical approaches may help improve breast appearance and reduce discomfort:
- Massage – Gentle external massage can help break down capsule tissue and loosen the implant pocket.
- Ultrasound – Therapeutic ultrasound applied to the breast may help soften the capsule.
- Medication – Your doctor may prescribe medications like leukotriene inhibitors (Accolate, Singulair) that can reduce inflammation.
- Time – In some cases, mild contracture resolves on its own over several months.
However, these conservative measures are generally unsuccessful for Grade III-IV contractures, which usually require surgery to correct.
Surgical treatment options
If you develop significant breast firmness, distortion, or pain from capsular contracture, surgery is typically needed. Options may include:
- Capsulectomy – The scar tissue capsule is surgically removed from around the implant.
- Capsulotomy – The contracted capsule is cut or released to loosen it.
- Implant exchange – The old implant is removed and replaced with a new one to improve breast shape.
- Implant removal – The implants are removed without replacement.
The best approach depends on several factors, including grade/severity of contracture, implant integrity, your goals, and surgeon preference. Discuss all options thoroughly with your plastic surgeon to select the appropriate treatment.
Can encapsulation be prevented?
While encapsulation can’t be prevented completely, the following may lower your risk:
- Choosing a smooth implant surface over textured
- Submuscular implant placement
- Diligent infection prevention during surgery
- Avoiding trauma like blows to the breast
- Prompt treatment of any hematomas or fluid buildup
- Rupture monitoring and replacement before significant deterioration
- Following post-op activity restrictions and recovery guidelines
Close follow-up with your surgeon as recommended can help detect any concerning changes early. But even with proper precautions, capsular contracture remains a possible complication for some patients.
What is the normal appearance of a breast with an implant?
A normal, non-encapsulated breast with an implant typically displays:
- Natural, teardrop shape without distortion
- Smooth, even edges of the implant
- No significant firmness or hard lumps
- Normal softness and mobility when palpated
- Minimal to no implant rippling/wrinkling visible
- No pain, tenderness, or enlargement
- No riding high on the chest or unnatural roundness
Minor firmness, mild shape changes with position, and some rippling can be normal early on. But any new, worsening changes warrant medical evaluation.
What is the prognosis for encapsulation?
The prognosis for breast implant encapsulation depends greatly on the grade:
- Grade I – Excellent prognosis with observation or mild treatments
- Grade II – Good prognosis with more aggressive non-surgical therapies
- Grade III – Fair prognosis with surgical release or implant replacement
- Grade IV – Guarded prognosis even with extensive surgery due to significant distortion
Higher grade contractures have increased risk of recurrence even after surgical correction. Encapsulation may also indicate impending rupture requiring implant removal. With early evaluation and proper treatment, many women can have good outcomes and retain their implants long-term.
When to see your doctor
You should see your doctor promptly if you notice any of the following:
- New breast firmness or shape changes
- Pain, tenderness, or enlargement
- Signs of inflammation like warmth, redness, swelling
- Rippling, ridges, or asymmetry of your breast
- Wrinkling, rash, or ulceration of the breast skin
Keeping up with your recommended follow-up exams can also help detect capsular contracture in earlier stages. Don’t delay seeking evaluation if you have any concerns about your breast implants.
Frequently asked questions
How soon can encapsulation occur after breast implant surgery?
Capsular contracture can develop soon after surgery or years later. About 50% of cases happen within the first 2 years after implantation. But encapsulation is possible at any time and should remain on your radar.
Can I prevent capsular contracture with massage?
Post-surgical breast massage may help reduce risk slightly but cannot prevent contracture completely. Massage is more useful for treating mild contracture by breaking up capsule tissue.
Do textured or smooth implants have higher encapsulation risk?
Textured implant shells correlate to a 2- to 3-fold higher risk of significant contracture versus smooth implants in studies. But neither prevents encapsulation entirely.
Can I still breastfeed after capsule removal surgery?
Breastfeeding is not expected after capsulectomy or implant removal since these disrupt breast ducts and glands. But in some cases, partial or limited breastfeeding may still be possible if any undamaged tissue remains.
Are there any home remedies to soften a contracted breast capsule?
No home remedies have been proven effective or recommended for a contracted capsule. Therapeutic massage and over-the-counter anti-inflammatories may offer mild temporary relief in very early cases.
How will I know if my breast implant ruptures from a tight capsule?
Signs suggesting implant rupture due to a contracted capsule include sudden pain, swelling, asymmetry, and implant deflation on one side. Imaging tests will confirm the rupture diagnosis.
Key takeaways
- Capsular contracture from breast implant encapsulation can cause pain, distortion, and firmness.
- Symptoms like shape changes, hardness, and implant rippling indicate possible encapsulation.
- Evaluation includes a breast exam, rating on the 4-grade scale, and sometimes imaging tests.
- Mild encapsulation can resolve with massage and medications in some cases.
- Higher grade contractures often require surgical release or implant exchange/removal.
- Promptly report any new breast changes to your doctor for assessment.
Breast implants do have risks, but appropriate follow-up and treatment can identify and manage complications like encapsulation. Maintain close communication with your plastic surgeon and follow all post-op instructions to help maximize your implant results and longevity.