Capsular Contracture: the hard breast after implants
Every implant forms a thin scar capsule around it — that is normal. When the capsule thickens and tightens, the breast can feel firm or hard, look rounder or sit higher, and sometimes ache. This is capsular contracture. Dr Thomas Colson assesses and treats it at SKMC in Abu Dhabi through breast implant revision.
Signs of capsular contracture
The signs of capsular contracture after breast augmentation are a breast that becomes firm or hard, looks rounder or sits higher than before, no longer matches the other side, feels tight, uncomfortable or painful, or shows a visible distortion of its shape; these changes can appear months or years after the original operation.
- Firmness — the breast feels firm or hard, when it was previously soft
- A rounder or higher breast — the breast looks rounder, or the implant sits higher on the chest
- New asymmetry — one breast no longer matches the other in shape or position
- Discomfort or pain — tightness, aching or tenderness that persists
- Visible distortion — a change in the contour of the breast, seen in the more advanced grades (Baker III–IV)
When to see a surgeon
Book an assessment when any of these changes appears or progresses. Capsular contracture is not an emergency, but a new firmness or change in shape should be examined, both to confirm the diagnosis and to exclude other causes such as a fluid collection or implant rupture. A new lump, swelling, redness or any sudden change is assessed promptly.
Assessment at SKMC
Dr Colson confirms capsular contracture by examination and, where needed, imaging such as ultrasound or MRI to grade the capsule and check the implant. A Crisalix 3D simulation can be used when planning the corrected shape.
A normal capsule that has tightened
After any breast implant, the body forms a thin layer of scar tissue — the capsule — around it. In most patients this capsule stays soft and is never noticed. In capsular contracture the capsule becomes thicker and contracts, squeezing the implant so the breast feels firm or hard, may look rounder or ride higher, and can become tender or painful.
Surgeons grade severity on the Baker scale, which guides whether the breast is simply watched or whether revision is advised.
Is this an emergency?
No. Capsular contracture is not dangerous in itself and there is usually no need to act overnight. A new firmness, change in shape or persistent pain should, however, be assessed — both to confirm the diagnosis and to exclude other causes such as a fluid collection or implant rupture.
Baker grades of capsular contracture
| Baker grade | What you feel | What you see | Usual management |
|---|---|---|---|
| I | Soft, like a breast without an implant | A natural shape | None — this is a normal capsule |
| II | Slightly firm | The breast looks normal | Monitoring |
| III | Firm | Visible distortion — a rounder or higher breast | Revision usually advised |
| IV | Hard, often tender or painful | Marked distortion | Revision advised |
Causes and risk factors
What contributes to it
The exact cause is not always known. Recognized contributors include a low-grade bacterial film (biofilm) on the implant, bleeding or haematoma after surgery, and factors related to the implant surface and pocket. It can appear months or years after the original operation.
How the risk is lowered
At SKMC, Dr Colson uses measures intended to reduce contracture risk: a Keller Funnel no-touch insertion that limits implant contact, careful control of bleeding, pocket irrigation, and an appropriate implant and plane. No technique removes the risk entirely.
How capsular contracture is corrected
Mild, early firmness (Baker I–II) is usually monitored. Established contracture that causes hardness, distortion or pain (Baker III–IV) is treated surgically, because the thickened capsule itself must be addressed.
Treatment is planned as a breast implant revision: removal of the thickened capsule (capsulectomy), exchange of the implant — often moving it to a prepectoral plane — and adjunct measures to lower the chance of recurrence. The exact plan depends on your anatomy and the grade of contracture.
A note on privacy and results
In strict compliance with UAE MOHAP regulations regarding patient privacy and modesty, before and after photos are not displayed on this website. A comprehensive medical portfolio is available for viewing during your private consultation.
A Crisalix 3D simulation of the planned breast shape is part of the consultation.
Frequently asked questions
What are the signs of capsular contracture after breast augmentation?
What does capsular contracture feel like?
Why does capsular contracture happen?
Can capsular contracture be treated without surgery?
How is capsular contracture corrected?
Will capsular contracture come back after surgery?
Have your implants assessed
In the UAE, consultations and surgery with Dr Thomas Colson are performed exclusively at Sheikh Khalifa Medical City (SKMC) in Abu Dhabi, within the SEHA network. If a breast has become firm, changed shape or is uncomfortable, it can be examined and, where needed, imaged to plan treatment.
Educational disclaimer
The information provided on this website is for educational and informational purposes only. It is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a qualified surgeon or health provider with any questions you may have regarding a medical condition.