Capsular contracture at a glance
- FrequencyLess than 1%
- Classification4 Baker grades
- Grade IIMonitoring, massage
- Grades III and IVImplant replacement
- CapsuleRemoved completely
- PriceOn quotation
A thin membrane, the capsule, forms around every breast implant. Capsular contracture (in French, « coque ») is when this capsule thickens and tightens: the breast becomes firm, then hard, the implant becomes rounder and may become tender. Capsular contracture is classified into 4 grades (the Baker classification). Once common, it has become rare: less than 1% in the series in Dr Médard de Chardon’s thesis, with silicone gel implants. At grade II, monitoring is enough; at grades III and IV, the implants are replaced and the capsule removed.
Price: implant replacement on a written quote after consultation (€100).
What is capsular contracture?
« Coque » is the everyday French term for periprosthetic capsular contracture. Around every implant placed in the body, a foreign-body reaction develops: a capsule, normally thin and supple, which always forms after breast augmentation with implants. Capsular contracture is an abnormal reaction of this capsule, which becomes thick and tightens: it distorts the implant (which becomes spherical), makes the breast firm to the touch and sometimes tender.
Under the microscope, a contracted capsule contains collagen fibres, histiocytes and sometimes synovial-type metaplasia.
Does capsular contracture only affect breast implants?
No. A contracted capsule can form around any implant: a breast implant, an orthopaedic implant (a hip replacement, for example) or a pacemaker. Because breast implants are soft, they are deformed when the capsule contracts, which is not the case with rigid implants.
What are the grades of capsular contracture?
The Baker classification distinguishes 4 grades:
| Grade | The breast | What to do |
|---|---|---|
| I | Soft, not distorted, not painful: normal capsule | Nothing |
| II | Firmer than normal | Monitoring, sometimes massage |
| III | Hard and distorted (spherical) | Implant replacement with removal of the capsule |
| IV | Hard, distorted and tender to the touch | Implant replacement with removal of the capsule |
Grade I: thin, supple, normal capsule; the breast is soft, not distorted and not painful. (default state).
- 1Capsule around the implant
- 2Implant
Is capsular contracture common?
Not any more. Capsular contracture used to be a common complication of breast augmentation; its frequency has fallen sharply thanks to improved practice and better-quality implants. In the study carried out by Dr Médard de Chardon for his thesis, the rate of capsular contracture after breast augmentation with silicone gel implants is under 1%, with no early grade III or IV contracture.
Can the risk of capsular contracture be reduced?
- Implant position: capsular contracture is less common behind the muscle or in a dual plane position than in front of the muscle, thanks to the constant massaging effect of the muscle.
- Implant quality: cohesive silicone gel implants.
- Operative precautions: careful control of bleeding, washing the pocket with an antibiotic solution, minimal handling of the implant.
Choosing a qualified, experienced and reputable surgeon reduces these risks, and can even eliminate some of them.
How is capsular contracture treated?
At grade II, simple monitoring is recommended, sometimes with massage.
At grades III and IV, further surgery is needed:
- complete removal of the capsule (total capsulectomy);
- thorough washing of the pocket with an antibiotic solution;
- placement of new implants;
- if needed, a change of pocket, for example from in front of the muscle to a dual plane position.
The operation takes place at Clinique Oxford in Cannes, after a consultation (€100), a written quote and the statutory 15-day cooling-off period.
To be avoided: the “squeezing” technique (closed capsulotomy), which involved forcefully compressing the breast and implant to break the capsule, should no longer be performed: it is pointless and dangerous.
What about polyurethane-coated implants?
Polyurethane-coated implants used to be placed to prevent capsular contracture from recurring. Since 5 April 2019, the ANSM (French National Agency for Medicines and Health Products Safety) has banned polyurethane-coated implants and macrotextured implants in France, because of a rare but serious risk of lymphoma (BIA-ALCL, breast implant-associated anaplastic large cell lymphoma). The ANSM does not recommend removing these implants as a precaution in women who have them: a breast examination every year is enough, and any swelling, pain or lump should prompt a consultation.
Dr Médard de Chardon’s experience
- MD thesis on breast augmentation with implants (Nice Faculty of Medicine, 2008).
- Presentation at the congress of the French Society of Plastic, Reconstructive and Aesthetic Surgery (SOFCPRE), Paris, 2008: “Primary breast augmentation for aesthetic indication: no early grade III or IV capsular contracture”.
- More than 3,000 breast implants placed; qualified plastic surgeon in plastic, reconstructive and aesthetic surgery, former Chef de Clinique (university hospital senior registrar), Nice Faculty of Medicine; member of SOFCEP (French Society of Aesthetic Plastic Surgery), SOFCPRE and ISAPS (International Society of Aesthetic Plastic Surgery).
See breast implant replacement before and after photos
Frequently asked questions about capsular contracture
How can I tell if I have capsular contracture around my breast implant?
The breast becomes firmer than the other one, then hard; the implant takes on a rounded shape and the breast may become tender. An examination by the surgeon allows the contracture to be graded according to the 4 Baker grades.
Is capsular contracture of a breast implant dangerous?
No, it is an excessive reaction of the membrane surrounding the implant. It is bothersome because of the distortion, the hardness and sometimes the pain in the breast; at grades III and IV, it warrants replacing the implants.
Is capsular contracture common after breast augmentation?
Not any more: under 1% in the series in Dr Médard de Chardon’s thesis, with silicone gel implants.
Can capsular contracture be treated without surgery?
At grade II, monitoring, sometimes with massage, is enough. At grades III and IV, only further surgery is effective. Compressing the breast (“squeezing”) is pointless and dangerous.
Can capsular contracture come back?
It can. Complete removal of the capsule, antibiotic washing of the pocket and, if needed, a change of implant position limit this risk.
Can polyurethane breast implants still be used?
No, they have been banned in France since April 2019. Women who have them do not need to have them removed as a precaution, but should have their breasts examined every year.
References
- Médard de Chardon V. MD thesis on breast augmentation with implants. Nice Faculty of Medicine, 2008.
- Médard de Chardon V. Augmentation mammaire primaire d’indication esthétique : aucune coque précoce de grade III et IV [Primary breast augmentation for aesthetic indication: no early grade III or IV capsular contracture]. Poster presentation, SOFCPRE congress, Paris, 2008.
- ANSM. Decision of 2 April 2019: withdrawal from the market of macrotextured breast implants and polyurethane-coated breast implants.