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What causes breasts to harden after breast implants?

Dr. Stuart A. Linder, MD
Plastic Surgeon

Breast hardening after implant placement is associated with scar tissue contracture, also referred to as capsular contracture. Capsular contracture is graded from Baker 1 through Baker 4. A Baker 1 is a soft breast. A Baker 2 is palpable scar tissue contracture. Baker 3 is palpable with visible contracture. Baker 4 is associated with palpable, visible, and hardening of the breast with sometimes a cold feeling to the breast itself. In Baker 4 capsular contractures there is severe disfigurement, often malposition of the implant and hardening. The specific etiology of capsular contracture is not completely delineated; however, scar tissue contracture may be associated with increased myofibroblast activity as well as increased collagen formation. It may be associated with microcontamination or infection often associated with Staphylococcus epidermidis that may have colonized the pocket. Surgery for capsular contracture that is severe, painful, or disfigured includes an open capsulectomy with removal of scar tissue or an open capsulotomy with release of the scar tissue.

Capsular contracture can cause breasts to harden after breast implants. Any time a foreign body is inserted into your body, the body forms a capsule around it. The capsule is generally soft and pliable, and is not palpable or noticeable. But that capsule can become hard, firm and noticeable. There are different grades of hardening, and based on that we decide whether intervention is needed. We take great lengths to make sure capsular contracture doesn’t occur, but it still can, often because of radiation therapy.

Dr. Mohammad Khosravi
Plastic & Reconstructive Surgeon

It is referred to a capsular contracture. After a breast augmentation using a breast implant, the human body will recognize it as foreign body and will produce a fibrous layer around called capsule. Nothing is wrong with capsule per se, in most cases we cannot feel or see the capsule, but in a certain percentage of patients the capsule starts to get hard and turn into a deep scar tissue which is called capsular contracture. Capsular contracture formation depends on multiple factors, including self resorbed small hematoma, medically treated postop (after surgery) infection, pocket placement of implants (above Vs. below the muscle), type of implant (Silicone gel filled vs. Saline filled, textured vs. smooth shell), however in most cases the causing factor is undetermined. Indication for Capsular Contracture is surgery (Capsulectomy) which is the removing of all scar tissue and hardened capsule. Non-surgical treatment of capsular contracture including capsulotomy is not successful in most cases. For patients who suffer from recurrent capsular contracture, we can use ADM that is the latest, the best however it will increase the procedure cost significantly. 

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.