Capsular Contracture on Screening Mammogram
On a screening mammogram, capsular contracture manifests as an implant that becomes more rounded in appearance rather than the normal oval shape, and this represents tightening of the fibrous capsule around the implant rather than a problem with implant integrity itself. 1
Mammographic Appearance
The key mammographic finding of capsular contracture is:
Change in implant contour from oval to rounded/spherical shape - This occurs as the fibrous capsule that naturally forms around all breast implants undergoes excessive contraction and tightening 1
Normal implant appearance: Oval, smooth, uniformly dense 1
Capsular contracture appearance: More rounded/spherical configuration due to circumferential capsular compression
Important Distinctions
What Capsular Contracture Is NOT:
- Not implant rupture - The implant shell remains intact; this is a capsule problem, not an implant problem 1
- Not indicated by capsular calcifications alone - While calcifications along the fibrous capsule are common in older implants (from chronic inflammation), they correlate with implant age but do not necessarily indicate contracture 1
What Suggests Implant Problems Instead:
- Undulations or contour irregularities - May indicate compromised implant integrity 1
- Frank bulges or herniations - Represent weakening of the fibrous capsule and potential weak points in the elastomer shell 1
Clinical Context
Capsular contracture is the most common complication following breast implant surgery 2, 3, 4. It results from excessive fibrosis and contraction of the normal fibrous capsule that forms around any implant, leading to:
- Capsule thickening and tightening
- Pain and discomfort (in symptomatic cases)
- Implant distortion
- The rounded appearance visible on mammography 2, 3
Key Mammography Limitations
Mammography cannot detect intracapsular implant rupture because silicone implants appear extremely radiopaque, preventing internal evaluation 1. The primary value of mammography for implant evaluation is:
- Detecting extracapsular silicone (high-density silicone outside the implant contour, indicating rupture) 1
- Monitoring contour changes over time by comparing with prior studies 1
- Identifying the rounded configuration suggesting capsular contracture
For actual implant integrity assessment in asymptomatic patients, MRI or ultrasound at 5-6 years post-implantation, then every 2-3 years is recommended per FDA guidelines 1.