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Capsular
Contracture
Revision
Capsular Contracture Revision
When any device is placed into the body, including breast implants, a very thin layer of scar tissue forms around the object. In breast augmentation, surgeons call this thin layer of scar tissue the breast capsule. Some patients’ bodies have an abnormal immune response that causes the scar tissue to become thick and tighten up around the implant in a process known as capsular contracture sometimes called implant encapsulation.
While mild cases of capsular contracture may go completely undetected, more severe cases can cause the breasts to look distorted in shape and they may even become painful to the touch.
Breast implant revision surgery can remove the scar tissue capsule and restore a soft, natural look and feel to your augmented breasts again.
Dr. James Koehler, Dr. Vincent Gardner, and the highly skilled team at Eastern Shore Cosmetic Surgery can help. Our board-certified cosmetic surgeons have more than 40 years of combined experience in breast enhancement procedures. With high standards for individual patient care and satisfaction, we have helped thousands of women throughout the Mobile-Pensacola area achieve amazing results while maintaining a natural-looking appearance.
Are You a Candidate?
Women who notice an unusual firmness around one or both breasts, a sudden change in breast shape or an increase in breast sensitivity may have capsular contracture, and could be candidates for breast implant revision. It’s also important to be in good overall physical and mental health, and to have realistic expectations about your results. During your consultation, your surgeon will go over all your options to help ensure that you’re a good candidate for capsular contracture repair before proceeding with surgery.
About Capsular Contracture
The causes of capsular contracture are unknown, although current research seems to indicate that a certain bacteria, staphylococcus epidermidis, which is present on our skin and also can be found in the milk ducts within the breast, may play a role in causing contracture. This bacteria can be found is as many as 70 percent of breast capsules with contracture.
There are four grades of capsular contracture:
- Grade 1: The breast looks and feels normal
- Grade 2: The breast feels slightly firm but looks normal
- Grade 3: The breast feels firm and looks abnormal
- Grade 4: The breast feels hard, painful to the touch and appears distorted
Some doctors further designate capsule contracture as “early” or “late” contracture. Early contracture occurs within the first year after augmentation and is more likely caused by bacteria, while late contracture can occur many years after implantation. In patients with silicone gel implants, late contracture may be caused by microscopic gel leakage which stimulates thickening of the scar tissue. Late capsule contracture is easier to treat than early.
Milder forms of capsular contracture may possibly be managed without surgery. Some surgeons recommend patients take vitamin E supplements to help soften the capsule, while others recommend taking milk thistle, an herbal supplement. However, there are no studies that prove or disprove these treatments’ effectiveness, and patients taking vitamin E need to stop at least 7-10 days before any surgical procedure due to risks of prolonged bleeding. Asthma drugs like Singulair have also been used to treat mild forms of capsular contracture, and have about a 50 percent success rate when taken daily for 90 days. While our surgeons may occasionally recommend these medications, at this point the research is not clear that the benefits outweigh the potential side effects of the medication.
If the breasts become markedly firmer, distorted in shape or feel painful, these symptoms indicate a Grade 3 or Grade 4 capsular contracture that could require surgery to correct.
As with many medical conditions, the best treatment for capsular contracture is prevention. Without knowing the precise cause, knowing how to prevent the occurrence of abnormal scar tissue growth is challenging. However, our surgeons take several precautions during breast augmentation surgery that have been known to decrease the likelihood of developing capsular contracture in the first place:
- Give intravenous antibiotics before surgery
- Perform not one but two full skin preps with surgical antiseptic: once prior to injection of local anesthesia, and another before surgical draping and incision
- Use submuscular implant placement whenever possible
- Minimize implant contact through the use of surgical powder-free gloves and use of the Keller Funnel
- Irrigate the implant pocket with an antibiotic solution, and ensure that no blood remains in the pocket
Implant type can also have an impact on capsular contracture. Silicone gel implants are most likely to become contracted and saline implants are the least likely, with gummy bear implants falling in between these two.
What to Expect
There are several surgical options surgeons may choose for treating capsule contracture:
- Capsulotomy: Your surgeon makes an incision (usually under the breast just above the inframammary fold) from which he or she can score or break apart the scar tissue by making small incisions in the capsule using cautery in the hopes that this will relieve the tightened capsule. However, capsulotomy is not very effective and has a high recurrence rate.
- Capsulectomy: Our surgeons generally prefer a full removal of the scar tissue capsule. They begin by making an incision, usually under the breast just above the inframammary fold. Next, they removes the entire capsule (or a good portion) and places a new implant. A drain tube is left in for several days to prevent fluid or blood from accumulating around the implant.
- Capsulectomy with Dermal Matrix: This is performed the same way as a capsulectomy, but the new implant is partially covered by acellular dermal matrix after being placed into the pocket.
Given the research that indicates the strong role bacteria seems to play in capsular contracture, Dr. Koehler and Dr. Gardner feel that complete removal of the contaminated capsule is best, and typically recommends a complete capsulectomy.
The next decision is whether to replace the same implant or use a new implant. Since research has shown that bacteria can form an irremovable biofilm on the implant, reusing implants allows for the chance that the bacteria can create another capsule. For this reason, our surgeons prefer using new implants whenever possible, and also lines the surgical pocket with acellular dermal matrix (usually Strattice) during surgery.
We are excited to offer Pro-Nox pain relief that can be added to any of the in-office procedures we perform. Pro-Nox is an inhaled analgesic that gives our patients 100% control through self-administration. Get short-term pain, anxiety, and stress relief without having to “go under.”
Dr. Koehler
Educated at the University of Alabama and in practice for over 20 years, Dr. Koehler is a board-certified cosmetic surgeon who is devoted to providing exceptional results.
Dr. Gardner
A triple-board-certified surgeon specializing in both cosmetic and venous procedures, Dr. Gardner brings a depth of expertise, compassion, and innovation to our practice.
Risks and Complications
The risks of implant revision due to capsular contracture are similar to those associated with any breast enhancement surgery, with the primary concern being the possibility of scar tissue recurrence. With capsulotomy or capsulectomy and placing a new implant, the chance of recurrence is between 20 to 25 percent, although this percentage decreases significantly when acellular dermal matrix is used. We will go over all the risks and benefits with you before your surgery so you’re fully informed about what to expect.
Your New Look
Recovery after your breast implant revision will likely feel similar to your first breast augmentation, although many women report the healing process as shorter and faster. You breasts should feel softer and more comfortable after surgery, with any contour irregularities resolved. Improvement is the goal of capsular contracture revision surgery rather than perfection, so it’s important to maintain realistic expectations about your new look.
The most significant benefit most women notice after capsular contracture revision is freedom from the issues that prevented you from fully enjoying the results of your initial augmentation, as well as the alleviation of discomfort and the reassurance of long-term positive results.
Capsular Contracture Revision FAQs
How much does capsular contracture revision surgery cost in Alabama?
The cost varies based on the severity of contracture, whether implants are replaced, your anesthesia fees, facility charges and other individual factors. Since each case is unique, an exact price is best given after a consultation where your specific needs and goals are discussed.
Is capsular contracture revision covered by insurance?
Insurance coverage depends on your policy and whether the contracture is considered a complication of a previous medically necessary surgery. Many plans do not cover cosmetic procedures, but you can contact your insurer to understand your benefits and any potential coverage for revision due to pain or functional issues.
What causes capsular contracture to develop?
Capsular contracture occurs when the scar tissue around a breast implant tightens and hardens. While the exact cause isn’t always clear, factors such as bacterial contamination, hematoma, seroma, implant rupture or individual healing responses can increase the risk.
Can capsular contracture come back after revision surgery?
While revision aims to correct the tightened scar tissue and reduce the chance of recurrence, it can still recur. Techniques like complete capsulectomy, implant exchange or changing implant placement can help to minimize recurrence, but no approach can guarantee prevention.
Can capsular contracture cause health problems beyond cosmetic changes?
Capsular contracture is primarily a structural issue involving scar tissue tightening around the implant, but in more advanced cases, it can cause significant discomfort, tenderness or changes in breast shape that affect daily activities. While it is not typically considered dangerous to overall health, persistent pain or noticeable distortion should be evaluated. Revision surgery can relieve discomfort, restore a softer feel and improve both appearance and quality of life.
How long is the recovery from revision surgery?
Recovery timelines vary, but most patients can expect initial healing in 1 to 2 weeks, with a gradual return to normal activities over 4 to 6 weeks. Your surgeon will give specific guidance based on the extent of surgery and your individual healing response.
Will I need new implants during revision?
Not always, but many women choose to have their implants replaced during revision. Your surgeon will determine whether your existing implants are suitable to remain or whether new implants might improve outcomes.
Does capsular contracture revision leave noticeable scars?
Revision uses incisions similar to your original augmentation, often placed in inconspicuous locations such as the breast crease or around the areola. Over time, scars typically soften and fade, and scar care recommendations can help improve their appearance.
Can revision surgery improve breast shape and symmetry?
Yes. In addition to treating the hardened capsule, revision surgery can address asymmetry, implant malposition or other contour concerns to help restore a more natural and balanced appearance.
Is ultrasound or MRI needed before surgery?
Your surgeon may recommend imaging to evaluate implant integrity, assess for rupture or help plan the revision. Your surgeon will determine whether ultrasound, MRI or other imaging devices are appropriate based on your symptoms and physical exam.
How do I know if I really have capsular contracture?
Signs include firmness of the breast, discomfort or pain, visual distortion of breast shape and high or tight implants. A physical exam can confirm the diagnosis and determine the severity, guiding the best treatment approach.
Written By: Dr. James Koehler
A board-certified cosmetic surgeon in Fairhope, AL, Dr. James Koehler earned his MD from the University of Alabama and completed several post-doctoral residencies, internships and fellowships. He returned to Alabama to be closer to family and serve patients in the local community with a full range of cosmetic surgery procedures for the face, breast and body.
More about Dr. James Koehler | Last Reviewed: March 4th, 2026
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