Capsular contracture is one of the most talked-about—and most misunderstood—complications following breast augmentation. While modern implant technology and refined surgical technique have dramatically lowered its incidence, capsular contracture can still occur and deserves careful attention from both patients considering breast implants and those experiencing postoperative changes.

At Dr. John Burns Plastic Surgery, the focus is not only on treatment, but on prevention, early detection, and long-term implant health, using the most advanced strategies available in breast surgery today.

What Is Capsular Contracture—And When Does It Become a Problem?

Whenever a breast implant is placed, the body naturally forms a thin scar capsule around it. This is normal and expected. Problems arise when that capsule thickens, tightens, or contracts around the implant.

When capsular contracture develops, patients may notice:
• Progressive breast firmness or hardness
• Visible distortion of breast shape
• Breast asymmetry
• Tightness, discomfort, or pain in advanced cases

Capsular contracture can occur months or even years after surgery, making long-term follow-up and implant selection critical.

Understanding the Baker Scale

Capsular contracture is clinically graded using the Baker Classification:
• Baker I: Breast feels soft and looks natural
• Baker II: Breast feels slightly firm but looks normal
• Baker III: Breast is firm with visible distortion
• Baker IV: Breast is hard, painful, and clearly abnormal

Grades I–II are often monitored or treated conservatively, while Grades III–IV typically require surgery.

How Common Is Capsular Contracture Today?

Thanks to modern implants and improved surgical protocols, capsular contracture rates are far lower than in previous decades.

• Current incidence: ~2–8%
• Risk increases over time, especially beyond 10–15 years
• Higher recurrence risk after previous capsular contracture

Risk varies based on:
• Implant surface technology
• Pocket placement
• Surgical sterility
• Postoperative inflammation
• Patient biology

What Causes Capsular Contracture?

Capsular contracture is multifactorial, meaning several contributors often overlap:
• Low-grade bacterial contamination (biofilm)
• Residual blood or fluid in the implant pocket
• Chronic inflammatory response
• Implant rupture or gel bleed (older implants)
• Radiation therapy
• Genetic predisposition to scarring
• Trauma to the breast

Today, the most widely accepted cause is subclinical bacterial contamination leading to chronic inflammation.

Implant Pocket Placement & Contracture Risk

Subglandular (Above the Muscle) Placement

• Higher historical contracture rates
• Greater exposure to breast duct bacteria
• Faster recovery—but higher long-term riskSubmuscular / Subpectoral Placement
• Lower capsular contracture rates
• Improved implant camouflage
• Reduced bacterial exposure

For patients with prior contracture, Dr. Burns often recommends a pocket change during revision surgery.

To understand newer above-the-muscle options with improved safety, read:
👉 https://drjohnburns.com/blogs/news/preservation-breast-augmentation

Dr. Burns frequently utilizes Motiva® next-generation silicone implants, which feature SilkSurface® nanotechnology—a precisely engineered 4-micron surface shown to reduce inflammatory response.

Motiva implants are designed to:
• Decrease bacterial adhesion
• Reduce inflammatory cell activation
• Lower capsular contracture rates
• Improve biocompatibility

Clinical data and global experience show some of the lowest reported contracture rates worldwide with Motiva implants.

Learn more about the science behind this technology here:
👉 https://drjohnburns.com/blogs/news/motiva-silk-surface-implant-technology

Motiva implants also serve as the foundation for PRESERVE™ minimally invasive breast augmentation, which further reduces tissue trauma:
👉 https://drjohnburns.com/blogs/news/preserve-breast-augmentation-motiva-implants-in-dallas-tx

Preventing Capsular Contracture: What Matters Most

The single most important preventive factor is meticulous surgical technique.

At Dr. Burns’ AAAASF-accredited surgical center, prevention protocols include:

• Completely dry implant pocket
• No residual blood or fluid
• Triple-antibiotic + Betadine irrigation
• No implant-to-skin contact
• Minimal implant handling
• IV antibiotics
• Optimal pocket selection

Prevention begins in the operating room—but implant selection and postoperative care matter just as much.

Treatment Options by Severity

Baker Grade I–II (Mild Contracture)

Non-surgical options may include:
• Montelukast (Singulair®) to reduce inflammation
• Implant massage
• Close clinical monitoring

Baker Grade III–IV (Moderate to Severe)

Surgery is usually required and may involve:
• Total capsulectomy (complete capsule removal)
• Implant exchange
• Pocket change, often to submuscular placement

This approach offers the highest chance of durable correction.

What If Capsular Contracture Keeps Returning?

Recurrent capsular contracture is challenging—but advanced solutions exist.

Option 1: Implant Removal + Fat Transfer

• Removes the source of scarring
• Uses your own fat for volume
• No future contracture risk
• Soft, natural breast feel

Learn more here:
👉 https://drjohnburns.com/blogs/news/fat-transfer-breast-augmentation

Option 2: Acellular Dermal Matrix (ADM) Support

• Capsule is surgically released
• ADM (e.g., Strattice®) placed as a biologic barrier
• Reduces recurrence in resistant cases

Why Patients Choose Dr. John Burns for Capsular Contracture Treatment

Dr. John L. Burns Jr. is a nationally recognized expert in advanced breast surgery, including:

• Primary breast augmentation
• Breast revision & capsulectomy
• Motiva® implant surgery
• Fat transfer breast augmentation
• PRESERVE™ rapid-recovery techniques

With more than 25 years of experience and a dedicated breast surgery practice, Dr. Burns delivers thoughtful, individualized solutions—even in complex revision cases.

If you’re experiencing breast firmness, pain, distortion, or asymmetry—or if you’ve had capsular contracture in the past—early expert evaluation is essential.

📍 Dr. John Burns Plastic Surgery – Dallas, TX
🌐 https://www.DrJohnBurns.com
📞 Call or Text: (214) 515-0002
📅 Online scheduling available

Modern implant technology and advanced surgical techniques offer excellent, lasting solutions—when guided by experience.