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Capsular Contracture of Saline Implants
Capsular contracture happens with saline implants just as it does with silicone — the capsule forms around the shell, not the filling. Every implant develops a capsule as a normal part of healing; contracture is that capsule tightening, and surgeons grade it on the Baker scale: Grade I, soft and natural; Grade II, slightly firm but normal-looking; Grade III, firm and visibly distorted; Grade IV, hard, painful, and abnormal. Grades III and IV are the ones that generally warrant surgery, which means removing the capsule and usually replacing the implant. As for cause, current thinking has largely settled on low-grade bacterial contamination — a biofilm on the implant surface driving chronic inflammation — which is why prevention now centers on submuscular placement, minimal implant handling, insertion funnels, and antibiotic irrigation of the pocket. One quirk specific to saline: a contracted capsule can sometimes fold or put pressure on the shell, and deflation announces itself unmistakably as a flat breast over a day or two. If your breast is getting firmer or changing shape, have it examined and graded.
Clinical Context
Capsular contracture can develop after any breast implant surgery, saline or silicone, and typically shows up months to years after the original surgery. Firmness or shape change is usually gradual, but should prompt an exam rather than a wait-and-see approach. Treatment decisions depend on how firm or distorted the breast has become and whether there's pain, not on implant type alone. Catching changes early generally makes correction more straightforward than waiting until the capsule is long-standing and severe.
