Capsular Contracture
What it is, how it is graded, and when it actually needs treating
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- Baker grading at assessment — you are told which grade you are and what it means
- Free consultation — £25 booking deposit, redeemable against any treatment
- Consultant plastic surgeons, GMC specialist register
- Not every capsule needs surgery — Grade I and II are often left alone
- CQC registered hospital in central Manchester
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Capsular Contracture
Hardening Around a Breast Implant — Assessment and Treatment in Manchester
Every breast implant forms a capsule. That is not a complication — it is the body doing exactly what it does around any implanted device, walling it off in a thin layer of scar tissue. In most women that capsule stays soft, thin and invisible, and they never know it is there.
Capsular contracture is what happens when that capsule thickens, tightens and contracts around the implant. The breast becomes firm, then hard; the implant is squeezed into a rounder, higher shape; and in the more advanced grades it becomes visibly distorted and genuinely painful.
It is the commonest long-term complication of breast augmentation. It is also the one most often misunderstood by patients, because the word “contracture” gets applied to everything from a breast that simply feels firmer than the other to a breast that is hard, cold and distorted. Those are very different situations with very different answers, and the difference between them has a name: the Baker grade.
The Baker Grades
How capsular contracture is classified
Understanding Your Grade
Baker’s classification has been the standard since the 1970s and it is what your surgeon will use. It runs from I to IV and it is assessed by examination — by looking and feeling, not by scan.
Grade I. The breast is soft and looks natural. The capsule is present, as it always is, but it is causing nothing. This is the normal state after augmentation and it is not a diagnosis of anything.
Grade II. The breast is slightly firm to the touch but still looks entirely normal. Minimal, and usually left alone.
Grade III. The breast is firm and looks abnormal — too round, sitting too high, visibly different from the other side. This is the point at which most surgeons start discussing surgery.
Grade IV. Firm, distorted and painful. The breast may feel cold and hard, the implant sits high and rounded, and the discomfort is constant rather than occasional. This needs treating.
The practical line is between II and III. Grades I and II are common, stable, and in most cases best left completely alone. Grades III and IV are the ones where surgery is worth considering, and being told plainly which side of that line you sit on is the single most useful thing an assessment gives you.
What makes a capsule contract?
The honest answer is that it is not fully understood, but the balance of evidence points to low-grade bacterial contamination of the implant surface forming a biofilm — a thin bacterial layer the immune system cannot clear but keeps reacting to. That reaction drives the capsule to thicken.
Recognised contributing factors include bleeding or haematoma around the implant at the time of surgery, infection, implant rupture with leakage, radiotherapy to the breast, and the implant being placed in front of the muscle rather than behind it. Smoking makes everything about implant surgery worse.
It is worth saying clearly: capsular contracture is not caused by anything you did. It is not a sign you exercised too soon, wore the wrong bra or massaged too little or too much. Patients often arrive convinced they caused it. They did not.
When Firmness Is Normal, and When It Is Not
Capsular Contracture Assessment in Manchester
A breast that feels slightly firmer than it did at six months, or slightly firmer than the other side, is extremely common and usually means nothing. Implants settle, capsules mature, and the two sides rarely end up identical. If your breasts look normal and you are not in pain, the likelihood is that you have a Grade I or II capsule and that the right course of action is to do nothing at all.
What warrants assessment is change: a breast that is getting progressively firmer, riding higher than it used to, changing shape, or starting to ache. Sudden change — particularly with swelling, redness or pain — should be seen promptly, because that is a different problem.
Deansgate Hospital is a CQC‑registered independent hospital in central Manchester. Assessment is with a consultant plastic surgeon on the GMC specialist register, and it is an examination and a conversation, not a sales appointment. If the answer is that your capsule does not need treating, that is what you will be told.
What Can Be Done About It?
The treatment options, and when each one applies
There is no reliable non-surgical treatment for established capsular contracture. Massage, ultrasound and various supplements are widely suggested online; none has good evidence behind it for a capsule that has already contracted. Some surgeons prescribe a leukotriene inhibitor off-licence with mixed results. What follows is what surgery can actually do.
1. Leave It Alone — Grade I and II
The right answer far more often than the internet suggests. A capsule that is causing no visible change and no pain does not need an operation, and operating on it exposes you to the risks of surgery for no gain. Many Grade II capsules stay stable for decades. You are reviewed rather than treated, and you come back if things change.
2. Capsulectomy with Implant Exchange — from £6,950
The standard treatment for Grade III and IV. The thickened capsule is removed, the old implant is removed, and a new implant is placed — usually in a fresh plane, most often behind the muscle if it was previously in front. Removing the capsule and changing the pocket is what reduces the chance of it happening again; simply swapping the implant does not.
3. Capsulectomy with Explant — from £5,000
Capsule and implant removed, with nothing put back. Appropriate if you have decided you no longer want implants, or after repeated contracture. What the breast looks like afterwards depends on how much of your own tissue remains and on your skin quality — this is discussed honestly before surgery, not after.
4. Capsulectomy with Explant and Uplift — from £8,950
Where the skin envelope will be left loose once the implant is out, an uplift at the same time reshapes what remains. It adds a scar and it adds cost, but for many women it is the difference between a result they are happy with and one they are not.
To find out which Baker grade you are and whether treatment is warranted, book an assessment in Manchester on 0161 470 9280 or enquire online. If the answer is that nothing needs doing, we will say so.
How common is it, and will it come back?
Recurrence and realistic expectations
Capsular contracture is the most frequently reported long-term complication of breast augmentation. Most cases that occur do so within the first two years, though it can develop at any point in the life of an implant, including many years later.
Recurrence after treatment is the part patients are least often told about. Having had one contracture makes another more likely than it was the first time, and each subsequent operation on the same breast tends to be harder than the last. That is not a reason to avoid treatment when it is warranted — it is a reason to make sure the first operation is the right one, done properly, with the capsule removed rather than just opened and the implant plane changed.
It is also a genuine argument for considering explant without replacement if you have already been through this more than once. A number of women reach a point where the most sensible option is to stop, and a surgeon who never raises that possibility is not giving you the full picture.
One Side or Both?
Contracture is usually one-sided, which is precisely why it becomes noticeable — you have the other breast for comparison. It does not mean the second side will follow.
Is It Dangerous?
No. Capsular contracture is uncomfortable and it distorts the breast, but it is not dangerous in itself and it does not become cancer. It can, however, make a rupture harder to detect, which is why a changing breast is worth assessing.
Capsular Contracture and Implant Rupture
Two different problems that often get confused
Contracture and rupture are separate things, though they can occur together. A contracture is the capsule tightening; a rupture is the implant shell splitting. A modern cohesive silicone implant that ruptures often produces no obvious symptoms at all, which is why rupture is sometimes only found on imaging — MRI or high-resolution ultrasound.
The two are linked in one direction: a rupture with silicone leakage into the capsule can provoke a contracture. If your breast has changed shape or firmness and you have had implants for more than ten years, imaging is a reasonable part of the assessment rather than an upsell.
Implants are not lifetime devices. Neither contracture nor rupture means you did anything wrong, and neither is an emergency — but both are reasons to be seen.
What Treatment Costs
From £5,000
If treatment is needed, prices at Deansgate Hospital start from: £5,000 for capsulectomy with implant removal, £6,950 for capsulectomy with implant exchange, £8,950 for implant removal with an uplift, and £9,500 for implant exchange with an uplift.
The fee covers your surgeon, your anaesthetist, the hospital and all routine follow-up. Implants are quoted separately. Surgical bras and compression garments are not included.
Assessment itself is a free consultation with a £25 booking deposit, redeemable against any treatment you go on to have. If the assessment concludes that your capsule does not need surgery — which for Grade I and II it usually will — there is nothing further to pay and nothing further to do.
Assessment and Treatment, Step by Step
What happens from first appointment to twelve-month review
An assessment for capsular contracture is an examination, a grading and a recommendation — which may well be that nothing needs doing. Where surgery is warranted, here is what it involves.
Your surgeon examines both breasts standing and lying down, assesses firmness, shape, implant position and symmetry, and assigns a Baker grade to each side. You will be asked what you know about your implants — make, size, year, and whether they sit in front of or behind the muscle. Bring your implant card if you have it; if you do not, that information can usually be traced.
Where a rupture is suspected, or where implants are more than ten years old and the breast has changed, imaging is arranged — ultrasound first, MRI where needed.
You are then told your grade plainly and what it does and does not mean. Photographs are taken for your record. There is no pressure to book anything.
The decision rests on three things: your Baker grade, whether you have pain, and whether the appearance bothers you. Grade I and II without symptoms is a watch-and-review situation. Grade III is a judgement call that belongs to you once you understand the trade-offs. Grade IV, particularly with pain, is usually worth treating.
Against surgery: it is a bigger operation than your original augmentation, recurrence is a real possibility, and each subsequent operation on the same breast is harder. In favour: an established Grade III or IV capsule does not resolve on its own and tends to progress slowly.
You will also be asked to think about whether you want implants at all going forward. It is a fair question and nobody should be embarrassed to answer yes or no.
Under general anaesthetic, the capsule is removed — a capsulectomy — rather than simply cut open. Where the capsule is adherent to the chest wall or the ribs, a partial capsulectomy may be safer than attempting to take every fragment, and your surgeon will explain if that applies to you.
If a new implant is going in, the pocket is usually changed — most commonly moving from in front of the muscle to behind it, or creating a fresh plane — because returning a new implant to the same diseased pocket is the single commonest reason contracture comes straight back. Where the skin will be left loose, an uplift is performed at the same time.
The operation takes longer than a straightforward augmentation, typically two to three hours. Deansgate Hospital is a day-case facility, so you go home the same day once your surgeon and the recovery team are happy with you.
Week 1. More uncomfortable than a first-time augmentation, because more work has been done to the pocket. Simple painkillers manage it. Support bra day and night. No lifting above shoulder height, no driving.
Week 2. Reviewed in clinic. Swelling and bruising settling. Most people with desk-based jobs are back at the end of this week or the start of the next.
Weeks 3 to 6. Light walking only — nothing strenuous, nothing that raises your heart rate or blood pressure. Support bra around the clock for the full six weeks.
Six weeks onwards. Exercise resumes, including chest and upper body work. The breast continues to soften and settle for three to six months, and the final result is judged at six.
Capsulectomy carries the risks of any breast operation — bleeding, infection, seroma, altered sensation, asymmetry and scarring — plus some specific to this procedure. Removing an adherent capsule from the chest wall carries a small risk of injury to the underlying structures, including pneumothorax. Blood loss is greater than in a primary augmentation.
The risk patients most need to understand is recurrence. Capsular contracture can and does come back, and having had it once makes it more likely. No surgeon can promise otherwise, and one who does should be treated with suspicion.
Where the implant is not replaced, the appearance of the breast afterwards is the commonest source of disappointment — not a complication, but a consequence. That conversation happens before surgery.
Your surgeon will also discuss BIA-ALCL and breast implant illness with you as part of the consent process for any implant operation, and you will be given written information on both.
Deansgate Hospital is a registered independent hospital in central Manchester with its own theatres and its own team. Your consultant plastic surgeon is on the GMC specialist register, you meet them at assessment, and they perform the operation themselves.
The thing that matters most for this particular problem is that we are willing to tell you not to have surgery. A great many capsules are Grade I or II and need nothing. Aftercare, follow-up and any revision required for a surgical complication are included in the quoted fee.
Capsular Contracture
Frequently Asked Questions
What does capsular contracture feel like?
It starts as a breast that feels firmer than it used to, or firmer than the other side. As it progresses the breast becomes hard, sits higher on the chest and looks rounder than it should. In the more advanced grades it aches or is constantly uncomfortable, and the implant may feel cold and immobile. A breast that is simply a little firmer than it was at six months, with a normal appearance and no pain, is usually a Grade I or II capsule and needs nothing done.
What are the Baker grades?
Grade I: the breast is soft and looks normal. Grade II: slightly firm but looks normal. Grade III: firm and looks abnormal — too round, too high, visibly different. Grade IV: firm, distorted and painful. The practical line is between II and III. Grades I and II are common and usually left alone; Grades III and IV are where surgery is worth considering.
What causes capsular contracture?
It is not fully understood, but the leading explanation is low-grade bacterial contamination of the implant surface forming a biofilm that the immune system keeps reacting to. Recognised contributing factors include bleeding or haematoma at the time of surgery, infection, implant rupture, radiotherapy, and implants placed in front of the muscle rather than behind it. It is not caused by anything you did or failed to do.
Can it be treated without surgery?
Not reliably, once it is established. Massage, ultrasound and various supplements are widely recommended online without good evidence behind them for a capsule that has already contracted. Some surgeons use a leukotriene inhibitor off-licence with mixed results. If you have a Grade I or II capsule, the treatment is usually to leave it alone and review it.
Will it come back after surgery?
It can, and having had it once makes recurrence more likely than it was first time round. That is why the operation matters: removing the capsule rather than simply opening it, and changing the implant plane, meaningfully reduces the chance compared with just swapping the implant. No surgeon can promise it will not return, and you should be wary of one who does.
Do I have to have the implant replaced?
No. Removing the capsule and the implant without putting a new one in is a perfectly reasonable choice, particularly if you have been through this more than once. What the breast looks like afterwards depends on how much of your own tissue remains and on your skin quality, and an uplift at the same time is often what makes the difference. That conversation happens before surgery, not after.
Is capsular contracture dangerous?
No. It is uncomfortable and it distorts the breast, but it is not dangerous in itself and it does not turn into cancer. It can make an implant rupture harder to detect, which is one reason a breast that is changing is worth having assessed.
How is it different from a ruptured implant?
They are separate problems. A contracture is the scar capsule tightening around the implant; a rupture is the implant shell splitting. A modern cohesive silicone implant can rupture with no obvious symptoms, which is why rupture is often only found on ultrasound or MRI. The two are linked in one direction: a rupture leaking into the capsule can trigger a contracture.
How soon after my augmentation can it happen?
Most cases occur within the first two years, but it can develop at any point in the life of an implant, including many years later. Sudden change — particularly with swelling, redness or pain — should be seen promptly, because that suggests something other than a slowly progressing capsule.
What does treatment cost in Manchester?
At Deansgate Hospital, capsulectomy with implant removal starts from £5,000, capsulectomy with implant exchange from £6,950, implant removal with an uplift from £8,950 and implant exchange with an uplift from £9,500. The fee covers your surgeon, anaesthetist, the hospital and routine follow-up. Implants are quoted separately, and surgical bras and compression garments are not included.
Will my insurance cover it?
Usually not if the original augmentation was cosmetic, since most policies exclude complications of cosmetic surgery. Where implants were placed for reconstruction after cancer treatment the position may be different. Check with your insurer before your appointment, and we can provide the procedure codes you will need.
Can I be assessed if I had my surgery somewhere else?
Yes, and a large proportion of the people we see for this had their original operation elsewhere, including abroad. Bring whatever documentation you have — implant card, operation note, the clinic name and year. Where none of that exists we work from examination and, where needed, imaging.
Worried your breast is changing?
Capsular Contracture Assessment, Manchester
Most firm breasts after augmentation are Grade I or II capsules and need nothing at all. The value of an assessment is being told which you have, by someone who is prepared to tell you that the answer is to leave it alone.
If your breast has become firmer, changed shape, started sitting higher or become uncomfortable, book an assessment with one of our consultant plastic surgeons in Manchester. You will be examined, given your Baker grade, and told plainly whether treatment is warranted. Call 0161 470 9280 or enquire online.