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Grade IV capsular contracture in the right breast of a 29-year-old woman seven years after subglandular placement of 560cc silicone gel-filled breast implants

Capsular contracture is a common complication of breast implant surgery. Capsular contracture happens when the scar tissue or capsule that normally forms around the implant tightens and squeezes the implant. It can happen to one or both of the implanted breasts.

There are four grades of capsular contracture - Baker grades I through IV. The Baker grading is as follows:

• Grade I the breast is normally soft and looks natural
• Grade II the breast is a little firm but looks normal
• Grade III the breast is firm and looks abnormal
• Grade IV the breast is hard, painful, and looks abnormal.

Capsular contracture may be more common following infection, hematoma, and seroma. However, it is not known for sure why capsular contracture happens. The literature also discusses other factors, such as a textured implant surface and submuscular placement of the implant, which may decrease the capsular contracture rate.

A reoperation may be needed to correct capsular contracture, usually for grade III or IV capsular contracture. The surgical procedures range from removal of the implant capsule tissue with or without replacement of the implant itself. Capsular contracture may happen again after this reoperation.

An Institute of Medicine report stated in 2000 that the capsular contracture rates were 36-81% for silicone-gel filled breast implants and 8-41% for saline-filled breast implants.

Prospective studies of saline-filled breast implants approved by FDA in May 2000 showed rates of grade III or IV capsular contracture of 9% at 3 years and 10-11% at 5 years for augmentation patients. The same studies showed rates of grade III or IV capsular contracture of 25-30% at 3 years and 29-36% at 5 years for reconstruction patients.

• Section on Complications from the FDA Breast Implant Consumer Handbook - 2004. Most of the above text was copied verbatim from this public domain source.
• Safety of Silicone Breast Implants. Institute of Medicine National Academy Press, Washington, D.C. 2000.

• Capsular contracture photos