When a breast implant is placed, the body attempts to wall it off, forming a capsule around the implant. This capsule can be present within a week after surgery and is eventually present in all breasts containing implants. The result look of a breast containing implants is due to:
The capsule can be variable in thickness and have different properties from patient to patient, including right breast vs. left breast. Thicker capsules or those containing muscle cells can contract, misshaping the breast and, in some cases, causing pain—capsule contracture.
Precisely why some capsules become more problematic cosmetically speaking than others is unknown. The culprit is thought to be blood around the implant at the time of surgery or low-grade infection early or late after surgery.
Some capsules cause problems early after surgery, and some take years to transform into problematic capsules. In all cases of problematic capsules, the naturally round contour of the breast is flattened in one or more areas, including the upper portions of the breast. This can also occur if a breast implant breaks or ruptures.
Before the 1990s, this was treated by squeezing the breasts hard enough to break the capsule-closed capsulotomy. This resulted in high recurrence and implant rupture rates because the capsule was not removed. Currently, the standard of care is surgical removal of all or most of the capsules - total or subtotal capsulectomy - and replacement of the implant(s).
The goal is to allow the body to form a more favorable capsule and place a new breast implant that should last longer than the older one. External balms, medications, etc., do not effectively treat capsular problems. In some cases, capsule contracture, especially if mild and shortly after surgery, may be amenable to endermology (massage).