Capsular Contracture & Breast Implant

Scar tissue forms around all implanted materials in our bodies, as a natural part of healing, but scar tissue becomes troublesome when it tightens. 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 are often referred to as “coconut breasts.” Capsular contracture can occur anytime but tends to do so in waves called either “early” or “late” capsular contracture.

Capsular Contracture Classification

Correcting capsular contracture involves several factors including: the extent of the damage, how soon it occurred after implant placement, lifestyle, patient history and expectations. The most common classification system used by Board Certified Plastic Surgeons is the Baker Classification;

  • Baker I 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 meaning a visible change in shape or contour.
  • Baker IV …the breast is very firm to hard, easily palpable implant, significant visible appearance, may feel cooler to the patient, and is painful with normal activity and mild palpitation.

Capsular Contracture 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. 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.

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 desires & goals & providing a level of service that places safety & comfort alongside predictable & pleasing outcomes.

Capsular Contracture Factors

There are two categories of capsular contractures:

  1. Early capsular contracture occurs within weeks to months following implant surgery.
  2. Late capsular contracture occurs years after surgery.

The general thinking is that the inflammation that occurs in the breast implant area may influence the capsular contracture. Conditions that cause the inflammation include: hematoma (blood collection) in the pocket during surgery, seroma (fluid collection) around the implant following surgery, bacterial contamination during implant placement, and factors such as smoking and tobacco use that affect blood supply and healing. Late contractures may be related to a gradual reaction to the silicone shell or gel compounds.

Research has shown that placement of breast implants under the pectoral muscle results in fewer cases of capsular contracture. Dr. Rudderman can give you further information on this.

Dr. Rudderman uses an implant placement technique that is technically specific, respectful to the tissues & provides a precise implant pocket without trauma to those tissues. There is less swelling, less pain & little to no bruising…healing is faster.

Capsular Contracture Procedures

What is Capsular Contracture?

All breast implants placed in the body become surrounded by a layer of tissue called a capsule. In breast in most women this capsule lining is thin and soft. However some women will find that one or both breast become firm or hard overtime. This is called a capsular contracture. As the capsule tightens, there is often an associated change in shape.

How do I know if I have a capsular contracture?

When a capsular contracture occurs, the tightening will gradually make your breast feel hard because of pressure on the implant. The hardness can occur quite rapidly and be noticeable over days or weeks or in some women the tightening of the capsules may be so gradual that they may not be able to remember when their breast first became firm, hard, or misshapen.

What kind of symptoms might I have?

Many women will complain of 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.

What causes a capsular contracture?

Capsular contraction is believed to occur in some women as result of reaction to the natural bacteria within the breast tissue that stimulate response causing the capsule tissue to contract and tighten. These are not considered infections and treatment with antibiotics does not result in resolution.

Does a capsular contracture mean my implant is ruptured?

Capsular contraction can be associated with ruptured implants, particularly when significant chronic inflammatory changes occur. However patients with intact implants, saline or gel, may develop capsular contractures. Capsules when tightened may become thickened or remain thin and still cause implant shape change. Capsular contraction can occur with saline or silicone implants, textured or smooth implants and with implants placed above or below the muscle.

Can capsular contracture be treated without surgery?

There are several medications that have been reported to reduce the potential for recurrence of capsular contracture following surgery. Some patients have noted a stabilization of their tightening. It is extremely unlikely that any significant capsular contracture will resolve without surgery. Some surgeons have used a technique called closed capsulotomy to treat contractures without surgery. This is an outdated technique where the breast is squeezed to tear the lining and release the tension. There is a high risk of implant rupture with this technique and unpredictable tissue damage that most always results in more, not less scar tissue.

There are several supplements that have anti-inflammatory properties that have been reported to help reduce recurrence.

What is the best surgery for capsular contracture?

A total capsulectomy is removal of the entire lining around the implant. This effectively removes the inflamed tissue, the scar tissue, and removes the biofilm (bacteria) that may have been present near the implant. The pockets are irrigated with antibiotic solution and a new implant can be placed. The original implants should NOT be reused if a capsular contracture has occurred and is being treated.

Will my capsular contracture recur?

There is no way to accurately predict if you will have a recurrence. Women that have developed a contracture are definitely more likely to have a recurrence in the future.

What options do I have if I develop a second capsular contracture?

There are patients that have had a second operation to remove the capsule with success. There are options as well to use a graft material called Acellular Dermal Matrix during surgery after a capsulectomy (the operation to remove the capsule). This is not foolproof, but some studies have demonstrated decreased contracture rates after use of this material. This does require drains for 5+ days, and there is additional cost associated with use of this material. This option should be carefully discussed before surgery.

What happens if I do not want to replace my implants and how will I look?

Many women will decide not to replace implants. Your appearance after surgery will depend significantly on how much of your current breast volume is tissue vs. implant. Your cup size generally will be similar to your cup size before implants were placed. However, women who had had several pregnancies may have less OR more breast tissue than at the time of augmentation. Women who are near or through menopause may have experienced volume changes in breast, more commonly larger than smaller. Patients who have had gradual weight gain may as well have more native breast volume. And removal of implants placed above vs. below the muscle can impact the shape after surgery. All of these factors will be discussed during your consultation so that you can have a reasonable idea of possible outcomes before your breast implant removal surgery.

What happens to the tissue removed during a capsulectomy surgery?

When a capsulectomy (surgical removal of the tissue lining around your implant) is performed in effectively all operations with implant removal. If implants are removed without removal of the capsule, the capsule will persist indefinitely, and may scar together, but will not disappear. Retained capsuled may occasionally become a site for seroma (fluid collection) if retained. All capsules removed during surgery are sent to the Northside Hospital Pathology department for microscopic evaluation, and a report is generated for your medical record with findings noted. It is very rare for any neoplasm (cancer) to be related with capsule removal.

Does Dr. Rudderman perform the entire capsular contracture surgery?

Yes, he performs all of his patient’s surgeries. Many surgeons use assistants to suture or perform part of the operations. Dr. Rudderman performs the entire operation on every patient.

Will there be any pain with capsular contracture surgery?

All surgeries involve some discomfort. Dr. Rudderman is highly skilled and uses advanced techniques and refined instruments that maximize comfort during his surgical procedures. Many patients will take either minimal pain medications for several days and then convert to Tylenol.

How long before I can exercise after capsular contracture surgery?

You will need to avoid all rigorous, strenuous activities for a few weeks until healing is adequate and Dr. Rudderman tells you it’s ok. We will see you frequently during your healing process to help you return to your normal activity as soon as possible. Exercise can be an important part or recovery, and we follow your recovery closely to help you reach your goals.

How long before I can return to work after my capsular contracture surgery?

Dr. Rudderman’s patients most often return to desk jobs in about 2-4 days. Most operations for implant removal can be performed on Thursday with return to work on Monday. If drains are placed, they usually can be removed in 1-4 days as well. He can give you a time frame specific to you during your consultation.

Will I have a board certified anesthesiologist for my capsular contracture surgery?

Yes. All cases are supervised a Board Certified medical doctor who has specialized in anesthesiology.

Is the surgery done in an accredited facility?

All of our surgeries are performed in a fully accredited surgery facility using state of the art technologies and a world-class staff with all the comfort and safety factors as a hospital surgery suite.

Will insurance pay for capsular contracture surgery?

Capsular contracture surgery is usually considered to be cosmetic procedures, especially when the original surgery was cosmetic in nature. Cosmetic procedures are not covered by insurance. However, there may be exceptions for removal of implants and capsulectomy, so you should check directly with your provider for this answer.

Is financing available for capsular contracture surgery?

Yes. Financing through Care Credit is available for all the breast procedures Dr. Rudderman performs.

Will I need someone to take care of me after my capsular contracture surgery?

You will need someone to drive you to and from your surgery, stay during surgery and remain with your overnight (24 hrs) after you have had anesthesia. Your follow-up visit will usually be within 24 hours, and you should be able to drive to this appointment if you are not taking pain pills.

Treatment outcomes for capsular contracture of the breast are not predictable and recurrence is common. However, with well-planned, individualized treatments, it is often possible to achieve results that dramatically improve the situation.


Research shows that certain nutritionals, especially those with anti inflammatory effects, may reduce initial and recurrent risk of capsular contracture.

Asthma Drugs

Called leukotriene inhibitors affect the bodies’ response to inflammatory stimuli and may be useful in some cases of capsular contracture. There are side effects and most surgeons do not recommend this course of treatment.

Closed Capsulotomy

Involves an outdated procedure of “squeezing” the breast to release the capsule. This is painful and is not recommended as treatment for capsular contraction. Dr. Rudderman does not use this technique on any patient. Seek a second opinion if this is recommended to you by any surgeon.

Surgical Procedures for Capsular Contracture

Open Capsulotomy

Describes a surgery that opens and releases the capsule using an electro cautery. This procedure allows for the capsule to expand, resulting in a softer breast and more room for the breast implant. If the implant is in good condition, is placed above the muscle and is not leaky, this may be a good option.


Is surgery used to remove the entire capsular lining around the implant. This is performed for the following: the capsule is thickened, a history of previous infection exists, there was earlier trauma, if the implant is silicone gel and is ruptured, if the capsule has calcification plaques from older implant versions, and when removal of the capsule is required to restore a more normal breast shape. This surgery can be done enbloc meaning a larger incision is used and the capsule is not opened so the implant is removed with capsule intact. IN these cases a new implant is needed.

Replacing a breast implant may yield a better long-term result, especially if your current implants are from a previous “generation.”

Acellular Dermal Matrix for Capsular Contracture

Used daily in surgical/neurosurgical procedures around the world, Acellular Dermal Matrix (ADM) is a material derived from humans and animals and is used as transplant material in humans. New data shows that use of ADM may reduce rates of capsular contracture.

There are several options, as you can see. The information can be confusing and frustrating. Some women who come to me for treatment have gone through significant lifestyle changes, pregnancies, weight shifts, and aging with hormonal changes…all of which has affected their breast volume. Their goals have changed over time and they just want a healthy, natural looking appearance. That’s what I do during the detailed consultation. There are options today that match nearly every goal to achieve a beautiful, natural appearance.

  • Dr. Rudderman and his staff made the experience easy and comfortable. They were realistic communicating surgery expectations, expected pain levels and down time from work. Nurses were informative and friendly and wait times minimal. I also liked the fact that Dr. Rudderman does all his own work and doesn't let other less experienced people do parts of the surgery the way other doctors may. I'm only one week out of the surgery, but I am very satisfied with the results so far.

    Susan Parker | Atlanta, GA


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Dr. Rudderman’s unique, integrated approach to plastic surgery employs only safe, effective, predictable surgical techniques that are driven by uncompromising respect for the natural condition of the human form. He understands that the body changes with time – as do desires. His primary goal is to deliver the best possible plastic surgery … specifically matched to each patient…in a safe environment with ultimate respect for every single individual…their concerns and goals. LEARN MORE »

“The best plastic surgery results must give each individual the opportunity to feel comfortable now and in the future…”

Dr. Randy Rudderman


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