Capsular contracture is the most common aesthetic complication of breast augmentation. If you have a complication related to your breast surgery, it is most likely you will have this issue. The human body is an amazing structure. Anytime there is a foreign body implanted in the body, the body reacts by forming a protective lining around it. This is what we call a capsule: a layer of fibrous tissue around the implant. This layer forms in any part of the body any time an implant is used. This is a normal reaction, and most of the time it does not cause any serious effects or evolve into a capsular contracture. A capsular contracture is when the capsule that forms around the implant gets very thick and it actually squeezes the implant, resulting in pain, firmness, and distortion of the breast. The tighter the capsule becomes, the worse the symptoms related to the capsular contracture. If we look under the microscope, this capsule consists largely of cell core fibroblasts with connective tissue. A specialized fibroblast has been identified in the capsules of patients with capsular contracture. This cell type is considered responsible for making the actual scar squeeze the implant to various degrees. Think about this cell like a muscle cell that stretches and contracts. It is not well understood what causes myofibroblasts to appear in the capsule and how they regulate these contracture properties. Capsular contracture can vary based on symptoms and manifestation. A mild capsular contracture is one where the breast feels a little bit firm; in other words, there is a capsule, but it is not significantly contracting or distorting the breast. The more the capsule progresses, the firmer the breast is going to feel, resulting in a moderate contracture. Then we reach the level where not only does the breast feel firm, but also the breast starts to get an abnormal shape more like a ball, as the implant is being squeezed out of position, typically upwards. Finally, you can have the most severe capsular contracture, where the patient has significant firmness, distortion, and pain in the breast.