Almost everything written about capsular contracture starts by explaining that it is a complication of breast implants. That is true and it is not very useful, because it leaves out the part that decides what happens next: the implant is not what went wrong.

The capsule is normal. The contracture is not.

Put anything permanent inside the body and the body walls it off in a thin layer of scar tissue. With a breast implant that layer is called the capsule, and every single person with implants has one. A soft capsule is invisible, does nothing and is the expected result of healing.

Capsular contracture is that same capsule thickening and contracting. It stops being a sleeve and becomes a shell, and it tightens around the implant. The implant has not degraded, moved on its own or failed. It is being squeezed, and everything that follows is a consequence of that squeeze.

This matters practically, because it explains why exchanging the implant on its own does not solve anything. Put a new implant inside a capsule that has already thickened and you have changed the thing that was not the problem.

What it feels like, in the order it usually arrives

Firmness first. The breast feels harder than it used to. Frequently on one side only, which is what makes it noticeable, because the comparison is right there.

Then position. A tightening capsule tends to ride the implant upward. One breast starts sitting higher than the other, and clothing stops fitting the way it did.

Then shape. A capsule tightening in every direction pushes its contents toward a sphere. The breast becomes rounder and more obviously an implant, which is the opposite of what the operation was for.

Pain last, if at all. This is the one that misleads people. Because discomfort arrives late, an early contracture gets explained away as normal variation for a long time. Firmness without pain is still worth an examination.

How surgeons grade it

The Baker scale has four grades and it is genuinely useful, because it maps almost directly onto what gets done.

Baker I. Looks normal, feels normal. This is every well-healed implant.

Baker II. Slightly firm on examination, still looks entirely normal. Usually watched.

Baker III. Firm, and now the shape has visibly changed. This is where surgery enters the conversation.

Baker IV. Firm, distorted and painful. Surgical, and generally not something anyone wants to wait out.

The line that matters is between II and III, and it is the line between a change you can feel and a change you can see.

Why it happens, stated honestly

The mechanism is not fully settled, and a page that pretends otherwise is not being straight with you.

The association with the most support behind it is a low grade bacterial film on the surface of the implant. Not an infection in any sense a patient would recognise, and not something that makes anyone ill, but enough to keep the capsule irritated and to keep it laying down tissue. Much of modern implant technique, from how the implant is handled to what the pocket is irrigated with, exists to reduce it.

Blood or fluid collecting around the implant after the original surgery is also associated, as is previous radiation to the chest. So is an implant placed above the muscle rather than beneath it, though that is a tendency rather than a rule.

What no honest account can give you is a reason in your individual case. Plenty of people with every risk factor never develop it. Plenty with none of them do.

Things that do not fix it

Waiting. A capsule that has thickened does not thin out again on its own. The early stage can stay stable for a long time, and that is different from improving.

Massage, once it is established. If your surgeon asked you to massage in the early weeks, that has a rationale. It is not a treatment for a capsule that has already tightened.

Closed capsulotomy. This is the manoeuvre where the breast is compressed hard enough to tear the capsule from outside. It is no longer performed and it should not be offered to you. It can rupture the implant, the tearing happens where nobody can see or control it, and because the capsule that caused the problem is still in place the contracture tends to come back anyway.

What does fix it

Capsulectomy. Removing the capsule rather than simply cutting it open. This is the operation, and the distinction between removing and releasing is the single most important thing on this page. Releasing a capsule leaves the tissue that contracted still sitting in the pocket.

Exchanging the implant. Almost always done at the same time, because the pocket is open and a fresh surface in a fresh pocket is the point.

Changing the plane. Moving an implant that sat above the muscle to a position beneath it, or the reverse, creates a pocket that has not been involved. Whether that is right depends on what is found during the operation and on your own tissue.

Adding support. A tissue matrix can be used to reinforce the pocket in selected cases. It is a tool for a particular problem, not a routine addition.

Removing the implants and stopping there. This belongs on the list. For someone who has already been through one contracture, explant without replacement is a considered decision rather than a defeat, and it is chosen more often than the marketing around breast surgery would suggest.

Recurrence, said plainly

A breast that has had a capsular contracture is more prone to another one than a breast that has never had it. Removing the capsule instead of releasing it, and addressing whatever is modifiable in your particular case, moves the odds in your favour. Nothing removes them, and a surgeon promising that is telling you something they cannot know.

What to do with this

If the breast is firmer than it was and the shape is unchanged, that is worth an examination and probably not worth an operation yet. If the shape has changed, or there is pain, the conversation is a different one and it is better had sooner, because a contracture that has distorted the breast has already passed the point where watching it achieves anything.

Bring your operative record if you have it. Which implant, which plane and what happened during the original recovery all change the plan, and reconstructing that from memory is guesswork nobody needs.

Find out which grade you are actually dealing with

Firmness alone and a breast that has changed shape lead to different recommendations, and the difference is settled by an examination rather than by comparing photographs. Dr. Newman will tell you where you sit and whether anything needs doing now.

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Your body forms a thin layer of scar tissue around anything implanted in it, including a breast implant. That layer is called the capsule and forming one is normal. Capsular contracture is when the capsule thickens and begins to tighten, squeezing the implant rather than simply surrounding it. The implant itself is unchanged. What has changed is the tissue holding it.
The usual first sign is firmness rather than pain. The breast feels harder than it did, often on one side only, and it may sit higher than the other. As it progresses the shape becomes rounder and less natural, because a tightening capsule pushes the implant toward a sphere. Discomfort tends to arrive last, not first, which is why the early stage is so often dismissed.
Baker I is a breast that looks and feels normal. Baker II is slightly firm to the touch but still looks normal. Baker III is firm and the change is now visible in the shape. Baker IV is firm, visibly distorted and painful. The practical dividing line is between II and III: the first two are usually monitored, and the second two are the ones that bring people in.
It can appear within the first year or many years after surgery, and both are common enough that neither is a surprise. A change that comes on over weeks in a breast that had been settled for years is worth having examined promptly, because a sudden change has other possible causes that are worth ruling out.
Honestly, it is not fully settled. The association with the strongest support is a low grade bacterial film on the implant surface, too sparse to cause an infection anyone would notice but enough to keep the capsule inflamed. Blood or fluid collecting around the implant after surgery and previous radiation to the chest are also associated. Plenty of people with none of these develop it anyway, and plenty with all of them never do.
Massage may help keep a capsule soft early on if your surgeon has asked you to do it, but it does not reverse a capsule that has already thickened. The manoeuvre where the breast is squeezed hard enough to tear the capsule, known as closed capsulotomy, is no longer done. It can rupture the implant, it tears tissue in a way nobody can see or control, and the contracture usually returns because the capsule that caused it is still there.
Removing the capsule rather than releasing it. That operation is a capsulectomy, and in most cases the implant is exchanged at the same time. Moving the implant to a different plane and using a supporting matrix are both tools in the same operation depending on what is found. Removing the implants without replacing them is a legitimate choice rather than a failure, and some people choose it once the whole picture is in front of them.
Yes. A breast that has had one contracture is more likely than an untouched breast to form another, and any surgeon who tells you otherwise is overselling. Removing the capsule rather than simply cutting it open, and addressing whatever is modifiable in your particular case, is what shifts the odds. It does not eliminate them.

Related reading: breast implant removal and replacement for what the revision operation involves, breast implant illness symptoms for the different question people often arrive with alongside this one, under versus over the muscle for the plane decision, silicone versus saline implants, gummy bear implants, breast augmentation recovery, and how to choose a plastic surgeon.