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Capsular Contractures of Breast Implants: Grading and Treatment

Capsular contracture refers to tightening of scar tissue around a breast implant, causing the implant to look or feel hard.  The previous blog discussed the definition, mechanism, and risk factors for capsular contracture.  Now we’ll examine the grading system and treatment.

Grading of implant capsules (Baker classification)

Grade 1:  There is no capsular contracture.  Remember that formation of a capsule around a breast implant is expected and normal—there is a capsule surrounding every breast implant.

Grade 2: The implant looks normal but feels firm.  Most women find grade 2 capsules to be reasonably acceptable.  Many don’t even realize that the implant is firmer than normal.

Grade 3: The implant feels hard and looks abnormal.  The capsule tries to force the implant into a spherical shape, causing the implant to stick out too much and look too narrow.  The implant may look artificial or “stuck on.”

Grade 4:  Same as grade 3, but the contracture is so tight that it causes breast pain.

Treatment of capsular contracture

Grade 1: Normal capsule.  No treatment required.

Grade 2 : I generally recommend aggressive massage of the implants with implant displacement exercises.  These involve forcefully pushing the implant up, down, and toward the midline, trying to stretch and loosen the capsule.  These exercises are generally much more effective in the first 6 months to a year after surgery (while the implant capsule is still pliable) than after the capsule has matured.  Certain medications (discussed below) may also be considered, particularly if the capsule appears to be worsening.  There is no good reason to do surgery for a grade 2 capsule.

Grade 3-4:  If sufficiently bothersome, these contractures may benefit from surgical management.  The most common methods of surgery include capsulotomy (cutting the capsule to enable it to expand) or capsulectomy (removal of part or all of the capsule) with placement of a new implant.  For those women who would like to try nonsurgical management, there is anecdotal evidence that certain medications, including certain asthma medications, such as Singulair or Accolate, or high dose Vitamin E may lessen capsular contractures.  Like breast massage, these medications tend to be most effective for relatively early contractures.

Before: (actual patient)

After: (actual patient)

For more information about breast augmentation, please see

Ronald M. Friedman, M.D.

Director, West Plano Plastic Surgery Center

Former Chief of Plastic Surgery, Parkland Memorial Hospital, Dallas

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