What is Capsular Contracture?
A Capsule is the scar tissue that forms around all nonabsorbable implanted materials in our bodies, as a natural part of healing. But scar tissue becomes troublesome when it tightens around an implant. As the capsule tightens, a flexible soft natural shaped breast implant can become a firm round ball and result in changes in the shape of the breast. This is called a capsular contraction.
he breast capsule often becomes adherent to surrounding skin, breast tissue, muscle, and chest wall. When the capsule begins to tighten, this can cause discomfort or pain with exercise, sexual activity, and normal everyday living. Capsular contracture can occur after a Breast Augmentation with implants and causes the breast to feel firm, unnatural and often painful. The most severe cases can cause strange distorted breast shapes.
These breast capsular contractures can:
- Change the shape (appearance) and feel of the breast
- Affect sleep, exercise, and daily activities
- Contribute to muscle pain, shoulder pain, neck and back pain
- Cause the feeling of difficulty in taking a deep breath
- Result in cold feeling breast
Capsular contracture can occur anytime. Removal of the capsule with or without an implant exchange usually involves a drain and most women return to work in 7-10 days.
Quick Facts:
- Treatment usually involves surgery to remove the scar tissue (capsulectomy) and the implant
- Surgery Length: 1 to 1 1/2 hours depending on the plan
- Duration of Hospital Stay: Outpatient (if early morning surgery, usually home by noon)
- Time to Return to Work: If capsule removed, usually 1 week (7-10 days)
- Time to See Full Results: Varies depending on implant removal vs exchange vs breast lift with/without implant removal
Dr. Rudderman, has extensive experience in surgery for the treatment of capsular contracture, helping patients achieve their desired outcome.
Read Understanding Breast Implant Capsular Contracture a blog post with real patient experiences and pictures of encapsulated implant.
Why Do Contractures Happen?
Contractures can occur any time after the placement of breast implants. There are several probable causes of contracture.
Breast tissue naturally has bacteria. Breast implants over time may have bacteria that adhere to the implant shell, called a biofilm. This is not an active infection (often referred to as a subclinical infection), and does not respond to antibiotics, but can cause a slow inflammation, resulting in a gradual tightening of the capsule which can cause a shape change of the breast.
Some studies suggest that blood in the pocket at the time of augmentation may increase your risk, and some contractures do not have any known causes. Most women never experience tightening or contracture.
What Does Capsular Contracture Feel Like?
The signs and symptoms of capsular contracture can vary. Many women will complain of intermittent or daily pain, discomfort, soreness, or interference with physical or sexual activity when a capsular contraction occurs.
You may experience discomfort in the chest, shoulder, rib, and back, numbness, tightness, heaviness, or non-specific irritation from capsular contractures. Some women will be generally embarrassed to give someone a hug because their breast just feel too hard. Clothing may become an issue because of the firmness and shape change of the breast.
Real Patient Story
Elissa talks about her surgery for implant removal, capsulectomy, and a breast lift.
She originally came to Dr. Rudderman for an implant removal, but later discovered she had to have a capsulectomy performed.
Before and After Photos
These are real photos of patient capsules around the implant that were removed due to health issues or concerns.
Capsules will present differently in each patient. These photos represent the capsules removed from this particular patients.
How is Capsular Contracture Treated?
Some women may decide to have breast implants removed after developing a capsular contraction or may wish to have a revision and replacement of the implants. Current studies have shown that implants implants associated with capsular contracture should be removed and replaced after capsule is addressed (released or removed (capsulectomy), and placement of brand-new implants are recommended.
Keeping the original implants is not recommended since the implant surface has adherent bacteria called a biofilm. Most implant companies now provide a warranty for this condition.
Many patients choose to have implants removed and consider some reshaping surgery to achieve a more natural long term outcome. Replacing implants after a capsular contracture occurs continues to carry risks of recurrent contracture.
Baker Classification
Correcting capsular contracture involves several factors including: the extent of the contracture (Classification). Decisions for surgical options will consider the timing (how soon after augmentation did contracture occur), patient medical and lifestyle history, and patient desires and expectations. The most common classification system used by Board Certified Plastic Surgeons is the Baker Classification.
| Classification | Description |
| Baker 1 | Describes a breast that is soft and feels and looks normal. |
| Baker II | Involves a breast that is slightly firm, often feeling. different from the opposite breast, but with no visible changes. |
| Baker III | Capsular contracture is significantly firm, with visible changes in shape or contour. |
| Baker IV | The breast is very firm to hard, easily palpable implant, significant visible change, may feel cooler to the patient and is or may be painful with normal activity. |
About the Capsulectomy Procedure
A capsulectomy (the surgical removal of the capsule) is performed at the time of implant replacement to improve the likelihood of soft breast and potentially reduce the recurrence rate of the capsular contraction. Removal of the capsule generally results in a dramatic breast shape change.
These options, however, do not ensure that a capsular contraction will not recur, and patients that have had a contraction are considered a higher risk of subsequent capsular contractions. Patients who have capsular contractures and have already had a second contracture may consider implant removal and other options without an implant.
Types of Capsulectomy
| Type | Description |
| Complete Capsulectomy | Removal of the entire capsule surrounding the breast implant. Typically recommended for severe cases of capsule contracture or implant complications. Also referred to as a total capsulectomy. |
| Partial Capsulectomy | Removal of a portion of the capsule while preserving some of it. This may be performed in cases where the capsule is thin or for milder contracture cases. Some revision breast operations, or change in pocket location, may preserve capsule as part of the procedure to support the implant. |
| En Bloc Capsulectomy | “enbloc” resections “require” removal of implant and capsule as a single unit without creating any opening in the capsule and it is a term reserved for “tumor” resection. This approach by description is associated with additional known risk. This technique is more commonly successful in when implants are subglandular, with thicker capsules, and when associated with treatment of breast tumor or disease. |
The surgery technique goal with total capsulectomy is for safe removal of visible capsule and implant contents. This approach is designed to protect normal anatomy and structures adjacent to the capsule. Clinical studies currently support that this technique carries lower risk than more aggressive approaches of “en block” with statistically identical outcomes.
Should I Re-implant After the Breast Implant is Removed?
The decision to re-implant should be carefully deliberated. If you have developed a capsular contracture once, you are at higher risk of a recurrence. If your implants were originally above the muscle, the option of replacing below the muscle may be considered. In some cases, the best option is to remove the implant and capsule, allow for healing, then consider options at a later date.
All tissue removed during surgery will be sent to pathology for evaluation. It is extremely rare to find any issue with the tissue. However, patients that have had textured implants have a very small risk over time of developing BIA ALCL (breast implant-associated anaplastic larger cell lymphoma) which in the overwhelming majority of cases is cured with a capsulectomy. These can develop to look like a contracture but often present with a fairly rapid size increase over weeks to a few months. If ALCL is suspected, additional significant pre-operative work up is recommended including additional scans and tissue/fluid pathology evaluation.
What to Expect After Surgery
A capsulectomy operation involves making an incision along the breast crease, regardless of where your original incision was placed. The tissue is separated to expose the capsule that can be easily identified. The operation includes dissection (separation of the surrounding normal breast) tissue from the capsule.
A contracted capsule can be very thin or thickened, can look normal or be covered with calcified areas that resemble tiny eggshells. These findings are identified during surgery and rarely show up on scans including MRIs.
Most women find that following the operation they may need some pain relief for 24-48 hours, and most find that within 24 -48 hours acetaminophen is effective. Driving can resume in 3-4 days, return to exercise in 3 weeks, and swimming and beach visits typically in 1 month.
- You will wake up with a small dressing over the treated area and a surgical bra
- Mild swelling, & some discomfort is normal & to be expected – this resolve on its own and often requires some pain medication for 24 hours then only acetaminophen
- You will be seen in the office 24 hours post-surgery and given a more comfortable bra
- Swelling generally is mild and mostly resolves in 2-3 weeks
- Sutures are absorbable and do not need to be removed
- You will have a type of brown paper tape on the incisions to protect the area and help with minimal scar formation
- You will have a drain tube placed if you have had a capsule removed that needs to be checked several time a day, and we will speak with you daily during business hours to follow your progress and determine when to return to have drains removed.
- Most patients have drains removed in 5-7 days.
- Most patients who have surgery on Thursday can return to desk work Monday with drains or later without.
- Avoid strenuous activity for 3 weeks. Dr. Rudderman will tell you when you can start to exercise again
- Measurable results are typically visible immediately…but be patient…healing and stabilizing takes time. It can take months for the “new you” to be clearly seen.
Long-Term Results
The results of this procedure are long-lasting. A good follow-up plan is necessary. Additional surgery to further improve the appearance is unlikely unless an implant is replaced and a subsequent contracture recurs. All breast need good long term follow-up for evaluation of breast disease by your practitioner of choice.
Receiving a Professional Consultation
Dr. Rudderman believes the consultation is critical for you and him. The consultation includes the following: full evaluation of your original surgical experience including implant type and location, placement and technique used.
This information can yield insight into the contributing factors to the capsular contracture. During the consultation implant positioning, size, capsular contracture severity, and soft tissue characteristics will be assessed to estimate expected postoperative appearance. Many symptoms may resolve quickly after implant and capsule removal. Capsules removed are typically sent for pathologic evaluation, and patients receive a written report of findings from the pathologist.
All of your questions will be answered and your concerns addressed. Dr. Rudderman has done hundreds of breast surgeries and can project your likely outcomes. This is done in an embracing, relaxing environment. From the consultation evolves…trust, respect, mutual understanding and a personalized treatment plan.
These treatments are not an emergency, and plenty of time will be allowed to have a full conversation to consider options. Additional visits can be provided until you feel confident that you are making the best decision for yourself in health, safety, and outcome.
Dr. Rudderman has done hundreds of breast surgeries and can project your likely outcomes. From the consultation evolves…trust, respect, mutual understanding, and a personalized treatment plan.
After your first consultation with Dr. Rudderman, you will realize that there truly is a difference in how surgeons approach their profession. For Dr. Rudderman, that difference means understanding your goals and providing a level of service that places safety and comfort alongside predictable and pleasing outcomes.
Contact us at 678.566.7200 to meet with Dr. Rudderman in our Alpharetta or Midtown Atlanta offices.
Written and reviewed by:
Dr. Randy Rudderman, who is board certified by the American Board of Plastic and Reconstructive Surgery (1994). He practices medicine at his offices in Alpharetta and Atlanta. The content written reflects current accurate information and is consistent with ethical positioning of the ASPS. (American Society of Plastic Surgeons). Last modified: May 31, 2024
Learn more about Dr. Rudderman, his medical training, and credentials.
