Capsular Contracture of the Breast

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Capsular Contracture of the Breast

Scar tissue forms around all implanted materials as a natural part of healing. Scar tissue around a breast implant is not troublesome unless it tightens. An abnormally tight scar is known as a capsular contracture. As the tightening scar tissue forms around the breast implants, it may cause the breast to feel firm, unnatural, or even painful. When you see a breast that looks round and hard, it is probably due to capsular contracture. Capsular contractures may occur at any time, but tend to occur in two waves, which are referred to as “early capsular contracture” and “late capsular contracture.”


Dr. Romano is one of the most popular plastic surgeons in the Bay Area, performing revisions of breast augmentation procedures. He empathizes with women in this situation, and will explore a variety of options, including the noninvasive use of medications and vitamins that are believed to interfere with the collagen formation process, or ultrasound treatments that can soften the breast. However, surgery is often the mainstay of treatment. Dr. Romano skillfully remakes the old incision, removes the implant, along with the removal of the collagen capsule, and replaces the implant. This involves a relatively short procedure under a light general anesthetic. The surgery is safe and predictable and results are consistently very beautiful, quick to heal, and exceptionally natural.

Dr. Romano Explains

Capsular contracture (CC) is all about collagen. I see why patients are very realistic and motivated to just look normal again. Fortunately complete correction can be achieved in all but very rare circumstances, and I look forward to helping you with this issue.


We can consistently depend on proper collagen formation in our bodies to act as the backbone of the repair and healing process. Collagen also forms around any foreign object in our body to protect us from such implants, like breast implants. In this case the collagen that forms around breast implants is normal and is our friend. It becomes our enemy when this collagen formation increases. This is what causes capsular contracture. The resulting distortion of the breast’s look and shape and feel is not uncommon and is very disturbing to affected patients.


Collagen forms by a discrete mechanism in our body whenever there is a cut, wound, infection, or foreign-body implant. The formation of collagen can be modified or modulated to some small extent, but it mostly forms under its own control mechanisms. It is a three-dimensional structure that can be thin, strong, and pliable, or it can be very thick and immobile. Capsular contracture is the formation of collagen around a breast implant that has gone beyond the normal protective layer alone, becoming a strong, thick layer that thickens and contracts over the entire surface of the breast implant. Plastic surgeons have struggled for years with determining the cause of this condition so that we can prevent its occurrence. This has been challenging. We know that excessive bleeding at the time of breast implant surgery and infection around the implant are pretty sure causes. Less predictable causes, such as general infection, silicone leakage, bacterial spread in the body, patients who are thick scar “formers,” and trauma have also been implicated. When capsular contracture occurs in a breast, it involves the entirety of the collagen capsule and does not discriminate between top or bottom, middle or outside. Most of the time it is difficult to define the cause of capsular contracture in a patient. It can occur soon after surgery, years later, on one side or both, and to different degrees without any apparent rhyme or reason. Capsular contracture usually presents with a very minor degree of bulging of the upper pole of the breast, and the patient sees more fullness in the top of one breast than the other. In more progressed forms it occurs with this upper-pole fullness and bulging, hardening of the breast, and distortion with abnormal shape and flattening. Plastic surgeons have loosely categorized breast implant capsular contracture as Baker Class I, in which it is in its most minimal form, all the way to Baker Class IV, in which it is the most severe, hard, and distorted. In any form it may or may not be associated with some pain and tenderness from nerves that may be trapped in the scar tissue. Once a breast becomes affected by capsular contracture, this almost never gets better on its own. It may remain at whatever level (Class I –IV) for the rest of your life, get worse slowly, or get worse rapidly. It is virtually never a critical health problem, and with the exception of rare instances of pain, can coexist in your body forever with no health danger.

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