Firmness is worth checking, but it is not a diagnosis by itself. The first step is an examination that grades the change on a standard scale and looks for other causes. What happens next — monitoring, non-surgical aftercare or revision surgery — depends on what that examination shows.
At SM Plastic Surgery in Gangnam, Seoul, a message we often receive goes something like this: "My implants used to feel soft, and now one side feels harder. Is something wrong?"
Firmness is worth checking, but it is not a diagnosis by itself. The first step is an examination that grades the change on a standard scale and looks for other causes. What happens next — monitoring, non-surgical aftercare or revision surgery — depends on what that examination shows.
Why can an implant start to feel firm?
After any breast implant surgery, the body forms a thin layer of scar tissue around the implant, called the capsule. This is normal. In some people the capsule thickens and tightens over time, squeezing the implant. That tightening is called capsular contracture, and it is one of the main reasons an implant that once felt soft can begin to feel firm or look different.
What do capsular contracture grades 1 to 4 mean?
Surgeons commonly describe capsular contracture with the Baker grading system. It describes what is felt and seen, which is why an examination in person matters.
| Grade | How it is usually described |
|---|---|
| Grade 1 | The breast feels and looks natural |
| Grade 2 | A little firm, but the breast looks normal |
| Grade 3 | Firm, with a visible change in shape |
| Grade 4 | Hard, painful and abnormal in shape |
A grade describes the current condition; it does not predict how fast things will change. The surgeon decides on treatment based on the examination and on how the change affects you.
Can an implant rupture without any symptoms?
Yes. With silicone gel implants, a rupture can occur without pain or a visible change. This is often called a silent rupture, and a physical examination alone may not detect it; imaging such as ultrasound or MRI is used to confirm it. That is one reason check-ups are planned on a schedule rather than only "when something feels wrong."
Imaging such as MRI is also better planned on a regular schedule instead of waiting for symptoms. As a general reference, the US FDA suggests a first ultrasound or MRI 5 to 6 years after surgery for silicone gel implants without symptoms, then every 2 to 3 years. Your own schedule depends on your implant type and individual condition, and is set at consultation.
How is the capsule cared for after surgery at SM Plastic Surgery?
After breast implant surgery, the clinic's follow-up runs for a year: wound-check and follow-up visits at about one week and one month, then check-ups at 3, 6 and 12 months. Dr. Lee Moo-young sees these visits as his own responsibility. In a 2014 magazine interview, asked whether checking patients regularly was tiring, he answered:
"I feel reassured only when I see the progress myself, so it's fine. If a problem does occur, I need to be the one to find it right away so that it can be dealt with."
— Dr. Lee Moo-young, Weekly People vol.895, 11 April 2014 (excerpt, translated from Korean)
The clinic has also introduced CAPS, an ultrasound-based device designed for aftercare following breast surgery, used for early post-operative care around the capsule. It is one part of aftercare, it is not a treatment that prevents capsular contracture, and it does not replace examination or check-ups.
Massage after surgery is another question people ask. The timing and method differ by stage of recovery, and pressing hard on your own is not recommended. Follow the instructions given at your visits.
What if my implants were placed somewhere else?
Revision surgery — including implant exchange and surgery for capsular contracture — is part of the clinic's breast practice, including for implants placed at other clinics. Bring any details you have of the implant brand and size and the incision site. If you have Sebbin implants, note that production stopped after the manufacturer's liquidation in March 2025; regular check-ups, including imaging when the surgeon advises it, are the way to monitor them, and replacement can be discussed at consultation if you are considering it.
Frequently asked questions
Q1) One implant feels harder than the other. Do I need surgery?
A1) Not necessarily. Firmness needs an examination first. The grade, any other findings and how the change affects you are considered together before any treatment is suggested.
Q2) How common is capsular contracture?
A2) We do not quote a single percentage in an article, because reported figures vary between studies. Your own risk factors are discussed at consultation.
Q3) Does CAPS prevent capsular contracture?
A3) No. CAPS is used for early post-operative care as part of aftercare, but it is not a treatment that prevents capsular contracture, and it does not replace your check-ups.
Q4) If I feel nothing unusual, can I skip my check-ups?
A4) Check-ups are still worth keeping. A rupture of a silicone gel implant can happen without symptoms, and imaging is used to confirm it.
Results and recovery differ between individuals. Please make decisions after a full consultation with a plastic surgeon.
In breast revision, implant replacement, or capsular contracture correction, the extent of surgery depends on the existing capsule and tissue condition, and bleeding, hematoma, seroma, infection, swelling, and bruising may be greater than after the first surgery. Capsular contracture may recur, and implant displacement, asymmetry, tissue thinning, changes in sensation, and scarring may occur. Additional surgery may be needed, and results depend on the existing condition and are not guaranteed.