Overview of Capsular Contracture of Breast Implant and Its Grading Scale


What is capsule contracture?

Breast implants cause the formation of a collagen tissue capsule around the breast implants. Normally this is very soft and is unnoticeable.  However, in 7% of individuals, it can tighten and squeeze the breast implants and cause “capsule contracture”. Capsule contracture may be more common after infection, hematoma or seroma formation, or maybe related to genetic factors.

Implants Possibly Causing capsule contracture

It is more common with gel breast implants, smooth breast implants, and sub-glandular placement.  It can occur any time after the original breast augmentation procedure and can involve one or both breasts.


Symptoms range from firmness and mild discomfort to severe pain, distortion, rippling, or displacement of the breast implant.

Four-Grade Baker Scale for Capsular contracture

Capsular contracture can be graded from Baker I to IV depending on the severity:

  • Grade I:       No palpable capsule. Breast feels soft as an unoperated breast.
  • Grade II:     The breast is less soft and the breast implant can be palpated but is not visible.
  • Grade III:   The breast is harder, the breast implant is easily palpated and the breast implant is visually distorted
  • Grade IV:    The breast is very hard, tender, painful, and cold.  The distortion of the breast implant is severe.

Surgery requirements for Grade III and IV capsules

Surgery may be required for Grade III and IV capsules.  This may include exchanging the breast implants for a different type, removing gel breast implants and replacing with saline, changing the location of the breast implants from sub-glandular to a submuscular position, performing a ‘capsulotomy’ by cutting the capsule in several places or performing a ‘capsulectomy’ in which the capsule is completely removed.

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