Capsular Contracture after Implants: Prevention & Management
What is Capsular Contracture?
Capsular contracture is one of the most common complications after breast cancer reconstructive surgery. It occurs when the body forms tight, hard scar tissue around the implant, potentially leading to discomfort, breast distortion, and limited range of motion in the shoulder. The implant itself can feel stiff or sit in a different position. It can occur on one side only or both. Often it occurs on the cancer side; as more treatment occured there leading to a stronger ‘protection response’.
Some times the body has exaggerated responses; i.e. laying down too much scarring in the form of chording, frozen shoulder or keloid scarring or. These are a few of the breast cancer conditions that can impact shoulder function or cause pain. We learned about the bodies way of protecting us in a previous blog noting pain as protection; similarly a contracture is the body being too efficient at protection.
After breast implant surgery, your body forms a scar tissue capsule around the implant. This is a normal immune response. But in some cases, the capsule becomes abnormally tight, developing too much, resulting in capsular contracture.
Common Symptoms:
Breast hardness or firmness
Pain or tenderness in the breast or chest wall
Implant distortion or elevated appearance
Reduced mobility in the shoulder or upper body
numbness or tingling in the arms and or hands on the effected side
Classification:
Baker Grade I: Soft, natural appearance
Baker Grade II: Slight firmness, no visible change
Baker Grade III: Firm with visible distortion
Baker Grade IV: Hard, painful, and clearly misshapen
Combining Surgical Care With Physiotherapy = Better Outcomes
How to Prevent Capsular Contracture After Breast Implants
Prevention starts from the moment surgery is planned, we speak a lot of preparedness in the 5 stages of cancer rehab.. Here are essential steps to reduce your risk:
✅ Choose an Experienced Breast Surgeon
Select a surgeon who uses proper sterile technique, places implants under the chest muscle (subpectoral placement), and minimizes implant contamination.
✅ Follow All Post-Surgery Instructions
Take prescribed antibiotics
Wear your post-surgical support bra
Avoid lifting or strenuous activity during the early healing period
Start implant glides when recommended by your surgeon
✅ Quit Smoking Before Surgery
Smoking restricts blood flow and increases the risk of poor healing and capsular formation.
✅ Get Support with Cancer Physiotherapy
Having a personalized cancer rehab plan in place early decreases your risk. Gentle movement and self-massage techniques may help maintain flexibility in the developing capsule, and decreasing the risk of a contracture. A cancer physiotherapist can also perform additional implant gliding and soft tissue work to further help reduce the chance of contracture.
How Can Cancer Physio Help?
1. Postural Correction
Patients recovering from breast surgery often adopt protective or hunched postures. Physiotherapists correct these patterns to maintain balanced muscle tension and reduce pressure on the chest wall and implant.
2. Range of Motion (ROM) Exercises
Stretching and mobility exercises restore shoulder movement, prevent stiffness, and reduce capsule tightening around the implant. A personalized rehab plan will include shoulder exercises and implant gliding.
3. Scar Tissue Therapy
Physiotherapists use manual therapy, myofascial release, and silicone scar therapy to minimize thick scar development and encourage elastic healing. Self-massage techniques are taught and encouraged.
4. Cold Plunge
After the wounds are fully healed, it can be safe to try cold plunging following our cold protocol + safety guidelines. One plunge is good but it’s the regular act of cold immersion that has clear benefits. This can help bring circulation to the area of healing; imagine it as strength training but for your veins and arteries.
How to Manage Existing Capsular Contracture
For patients who have already developed capsular contracture (especially Grades I–III), physiotherapy can help reduce symptoms and improve function.
1. Manual Therapy
Hands-on mobilization techniques help soften surrounding tissues, reduce tension, and restore flexibility. Even more so when patients learn self-release techniques to perform daily.
2. Pain Relief Modalities
Dry Needling (when clinically indicated)
Therapeutic ultrasound
Moist heat therapy
These treatments improve circulation and reduce muscle guarding around the implant.Diclofenac creams and other ointments of choice
3. Personalized Exercises
Strengthening weak muscles (especially the upper back and shoulder stabilizers) promotes better posture, biomechanics, and implant support.
4. Post-Revision Recovery
At times, surgery is needed. Surgical correction of capsular contracture should always be followed with physiotherapy to accelerate recovery, prevents recurrence, and restores full function.
🎯 Takeaway:
Capsular contracture is a common but manageable complication of breast cancer implant surgery. Adding a breast cancer physiotherapist to your recovery team can significantly improve your comfort, mobility, and recovery.
Thank you for your interest in science and rehab,
Kindly, The Cancer Physio
