What Is Capsular Contracture After Breast Implants?

By Vireon Medical Editorial TeamFirst published 5 November 2026Evidence checked through 5 November 2026

Short answer

Capsular contracture is the hardening of a breast around an implant, caused when the layer of scar tissue the body naturally forms around the implant (the capsule) tightens and squeezes it. Mild forms may only make the breast feel firmer, while severe forms change its shape and can be painful. Severe contracture usually needs further surgery, and it can come back afterwards; the risk depends partly on where the implant sits and on its surface.

Key points

Every implant gets a capsule; contracture is when it tightens abnormally.
The Baker scale grades it from I (soft) to IV (hard and distorted).
Grades III and IV are considered severe and may need an operation.
Placement under the chest muscle is linked to lower rates.
It can recur after corrective surgery.

What happens in capsular contracture

The body reacts to any implant by forming a thin layer of scar tissue around it. Usually this capsule stays soft. In capsular contracture it thickens and shrinks, and the NHS describes the result as the breast feeling hard because scar tissue has shrunk around the implant.¹ The US Food and Drug Administration (FDA) adds that the tightening can be painful.²

Radiopaedia, a peer-edited radiology reference, describes it as the commonest complication after breast augmentation.³ Reported rates vary widely between studies, depending on implant type, placement, follow-up length and how contracture is defined, so a single reliable figure is not given here.

How it is graded

Clinicians usually describe contracture with the Baker classification, a simple four-point scale based on how the breast looks and feels.³

Baker grade	Feel	Appearance	Typical approach
I	Soft	Normal	Not classed as severe²
II	Rather hard to the touch	Normal	Not classed as severe²
III	Hard	Some distortion; the breast may look rounder or the implant sit higher	Considered severe; reoperation may be needed²
IV	Hard, with progressive hardening	Distorted	Considered severe; reoperation may be needed²

The Baker classification of capsular contracture.³

What affects the risk

The cause is not fully understood and is thought to involve several factors.³ A 2025 systematic review and meta-analysis of 24 studies looked at implant choices after breast augmentation.⁴

Placement: implants placed beneath the chest muscle (subpectoral) had substantially lower contracture rates than those placed above it, with an odds ratio of 0.35.⁴
Surface: smooth implants had higher contracture rates than textured implants, with an odds ratio of 2.80.⁴
Filling: no significant difference was found between saline and silicone implants, though the estimate was imprecise.⁴

The authors noted the lack of large randomised trials, so these associations are Moderate evidence rather than proof.⁴ Another review lists bleeding after surgery, infection and radiotherapy among recognised risk factors.⁵

The surface finding needs to be read alongside another risk. Textured implants are linked to a higher risk of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), a rare lymphoma, than smooth implants.² Choosing an implant therefore involves weighing different risks rather than avoiding all of them.

How it is treated

Grades I and II are not classed as severe. For grades III and IV, the FDA states that reoperation may be required, usually removing the implant, with or without replacing it, and that contracture can occur again after surgery.² International aesthetic surgery societies list capsular contracture among the reasons a surgeon may also remove the capsule (capsulectomy).⁷

Non-surgical treatment has been explored. Montelukast, an asthma medicine that blocks inflammatory signals called leukotrienes, has been used off-label (outside its licensed use). A small systematic review of five studies found it reduced contracture rates in some, mainly in milder grades, but concluded that severe cases still require surgery and that randomised trials are needed.⁵ The evidence for medicines is Limited.

Contracture is one reason the FDA advises that breast implants are not lifetime devices and that people with implants should assume they will need further operations at some point.⁶

When to seek medical advice

See your surgeon or GP if a breast with an implant becomes hard, painful or changes shape.² Small tender lumps can be a sign of a ruptured implant, which the NHS says will need removing.¹

Common questions

Can capsular contracture happen years after surgery?

Yes; implants need monitoring for as long as you have them, and the NHS notes some women need further surgery after about 10 years because of implant problems.⁶¹

Does the type of implant matter?

It appears to: smooth implants and placement above the muscle were linked to higher contracture rates in a 2025 meta-analysis, while saline and silicone did not differ significantly.⁴

If I have surgery for it, will it come back?

It can; the FDA notes contracture may occur again after corrective surgery.²

Is capsular contracture dangerous?

It is not a cancer, but severe grades can be painful and distort the breast.²³

Bottom line

Capsular contracture is a tightening of the natural scar capsule around an implant, ranging from barely noticeable to painful distortion. Placement and implant choice affect the risk, severe cases usually need surgery, and recurrence is possible.

Sources

NHS. Breast enlargement (implants). NHS website. https://www.nhs.uk/conditions/cosmetic-procedures/breast-enlargement/. Accessed 5 November 2026.
US Food and Drug Administration. Risks and complications of breast implants. FDA; 2023. https://www.fda.gov/medical-devices/breast-implants/risks-and-complications-breast-implants. Accessed 5 November 2026.
Radiopaedia. Breast implant capsular contracture. Radiopaedia.org. https://radiopaedia.org/articles/15597. Accessed 5 November 2026.
Haas E, Christodoulou N, Secanho M, et al. Capsular contracture after breast augmentation: a systematic review and meta-analysis. Aesthetic Surgery Journal Open Forum; 2025;7. doi:10.1093/asjof/ojaf003. https://repositorio.unesp.br/entities/publication/7623e3d6-9f8a-49d4-893b-90882fbcbc42/full
Prosenz C, Aschauer J, Thürlimann A, et al. The role of montelukast in the prevention and treatment of capsular contracture (Baker grade III–IV): a systematic review and case analysis. Aesthetic Plastic Surgery; 2026;50:3907–3915. doi:10.1007/s00266-025-05583-4. https://link.springer.com/10.1007/s00266-025-05583-4
US Food and Drug Administration. Things to consider before getting breast implants. FDA. https://www.fda.gov/medical-devices/breast-implants/things-consider-getting-breast-implants. Accessed 5 November 2026.
International Society of Aesthetic Plastic Surgery, The Aesthetic Society, Aesthetic Surgery Education and Research Foundation. Joint patient safety advisory: breast implant removal and capsulectomy. ISAPS; 2023. https://www.isaps.org/media/djtnnugi/230509-joint-patient-safety-advisory-breast-implant-removal-and-capsulectomy.pdf. Accessed 5 November 2026.

Article history

5 November 2026 — First published.