Every breast implant patient develops a natural scar tissue capsule around their implant, this is the body's normal response to a foreign object. In most patients, this capsule remains soft and the implant is undetectable. In some patients, the capsule tightens and contracts abnormally, squeezing the implant and causing firmness, pain, and distortion. This is capsular contracture, the most frequently reported long-term complication of breast augmentation.
The Baker Classification Scale
Capsular contracture is graded on the Baker scale from I to IV:
- Grade I: The breast is soft and looks completely natural. This is normal, all implants form a capsule at this level.
- Grade II: The breast feels slightly firm to the touch, but looks normal. Minimal discomfort.
- Grade III: The breast feels firm and begins to look abnormal, round, high, or distorted. Some discomfort or tenderness may be present.
- Grade IV: The breast is hard, painful, and visibly misshapen. This is the most severe stage and almost always requires surgical correction.
What Capsular Contracture Feels Like
Patients describe early capsular contracture (Grade II–III) as a progressive tightening sensation, as if the breast is becoming harder or more ball-like over time. Grade III often feels like squeezing pressure inside the breast. Grade IV can be genuinely painful, with a chronically tender, rock-hard breast that may feel warm. The progression can happen over months or years after surgery.
Causes and Risk Factors
- Subclinical (low-grade) biofilm or infection around the implant
- Hematoma or seroma after surgery that was not fully resolved
- Textured implants (now less commonly used) had higher rates historically
- Subglandular implant placement (above the muscle) has higher contracture rates than submuscular
- Prior radiation to the breast area
- Genetic predisposition to aggressive scar formation
Treatment Options
Grade I–II capsular contracture often requires no treatment or just monitoring. Grades III–IV typically require surgical intervention: capsulectomy (complete removal of the scar capsule) with or without implant replacement. With modern smooth, round implants placed submuscularly and the use of the "no-touch technique" during surgery, the risk of capsular contracture is significantly reduced.
Concerned about firmness or changes in your breast implants? Contact Svelta Plastic Surgery in Miami for an evaluation by our board-certified surgeons.