After getting breast implants, breast pain, hardness, and numbness can develop and last for years. These common complications may never go away. The most common complication of breast implants is capsular contracture. When you get breast implants, your body naturally responds to the foreign object by forming scar tissue around the implants. Capsular contracture occurs when the scar tissue tightens around the breast implant. This can cause the breast to harden and become very painful. It can also change the shape of the implant, making it look abnormal, as shown in the photo below.
To fix capsular contracture, doctors used to perform a “closed capsulotomy.” This painful procedure involves squeezing the breast very hard to break the scar tissue capsule. This procedure should never be done. Most plastic surgeons do not perform this procedure anymore, but some do. The squeezing can break the implant and the capsule. Closed capsulotomies are not effective, and capsular contracture often comes back.
A plastic surgeon will be able to diagnose capsular contracture through a physical and visual exam. There are different grades of capsular contracture (Baker I, Baker II, Baker III, and Baker IV). They are graded based on the severity of symptoms:
Baker Grading System for Capsular Contracture
| Baker I | Breast is soft |
| Baker II | Breast is slightly firm |
| Baker III | Breast is firm and possibly misshapen and uncomfortable |
| Baker IV | Breast is hard, painful, and misshapen |
Health insurance companies that will pay for breast implant removal usually cover removal when there is severe capsular contracture (Baker III and Baker IV). This is because severe, painful capsular contracture interferes with mammography (breast cancer screening). The pain from severe capsular contracture can also interfere with daily activities, such as reaching above your head.
Capsular contracture does not usually get better by itself. If your breasts become very painful or hard, you will need surgery. Your surgeon would need to remove the scar tissue capsule and the implant. It is possible that some of your own breast tissue will be removed during the surgery because it is attached to the scar tissue. This can reduce the size of your natural breast and/or change their appearance.
If you decide to have your breast implants removed and replaced, it is important to know that capsular contracture is likely to reoccur. Women who have already had capsular contracture are at an increased risk of developing capsular contracture again with their replacement implants. This could lead to an endless cycle of surgeries, so the best treatment option for capsular contracture is permanent removal of the breast implants.
All articles are reviewed and approved by Diana Zuckerman, PhD, and other senior staff.