Capsular contracture is treated through a range of options depending on severity, from nonsurgical therapies like ultrasound to surgical procedures that remove the scar tissue and replace the implant. Mild cases (Baker grade I or II) may not need treatment at all, while moderate to severe contracture (grade III or IV) typically requires surgery for lasting results.
How Severity Determines Your Options
Every breast implant develops a thin capsule of scar tissue around it. That’s normal. Capsular contracture happens when that capsule thickens and tightens, squeezing the implant and changing the look or feel of the breast. Plastic surgeons grade it on a four-point scale:
- Grade I: The breast looks natural, feels soft, and causes no symptoms. The capsule exists but isn’t causing problems.
- Grade II: The breast feels slightly firmer than normal, with minor cosmetic changes. Most people don’t seek treatment at this stage.
- Grade III: The breast is noticeably firm, may look distorted, and can feel uncomfortable.
- Grade IV: The breast is hard, visibly misshapen, and painful to the touch.
Grades I and II are generally monitored rather than treated. Grades III and IV are where treatment becomes necessary, and surgery is the most reliable path to correction.
Nonsurgical Treatments
For early or moderate contracture, some patients and surgeons try nonsurgical approaches before committing to an operation. These work best for grade II or early grade III cases.
External Ultrasound Therapy
Therapeutic ultrasound uses sound waves applied externally to soften the contracted capsule. In a five-year clinical study, about 83% of treated implants improved by at least one Baker grade after an average of 6.4 sessions scheduled daily until results stabilized. Nearly 59% of contractures improved all the way to grade I. Most patients needed fewer than eight sessions for a lasting result. This approach avoids surgery entirely, though it works better for less severe contracture and isn’t widely available at every practice.
Massage and Medication
Some surgeons recommend implant displacement exercises (regular manual massage of the implant) as a preventive measure or early intervention. Certain medications that reduce inflammation or inhibit scar tissue formation have also been tried, though evidence for these remains limited compared to surgical options. One thing you should never do: forcefully squeeze the breast to try to break the capsule yourself. The FDA explicitly warns against this technique, called closed capsulotomy, because it can rupture or damage the implant, cause internal bleeding, or create folds in the shell.
Surgical Options for Moderate to Severe Cases
When contracture reaches grade III or IV, surgery is the standard treatment. The specific procedure depends on how thick the capsule is, whether the implant needs replacement, and what caused the contracture in the first place.
Capsulotomy
An open capsulotomy involves making surgical incisions in the thickened capsule to release the pressure without removing it entirely. This allows the implant more room and restores a softer feel. It’s a less invasive surgery than full removal, but recurrence rates tend to be higher because the scar tissue remains in place.
Capsulectomy
A capsulectomy removes part or all of the scar capsule. In a total capsulectomy, the surgeon takes out the entire capsule along with the implant, then places a new implant (or the same one, if it’s intact) into a clean pocket. This is the most thorough surgical approach and carries lower recurrence rates than capsulotomy alone. Recovery typically involves wearing a compression bra over surgical dressings for several days to weeks and avoiding strenuous physical activity until fully healed.
Changing Implant Placement
If your original implant was placed above the chest muscle (subglandular placement), your surgeon may recommend moving it beneath the muscle during revision. Subglandular placement is associated with higher capsular contracture rates, while submuscular placement reduces the risk. The tradeoff: submuscular implants can shift slightly when you flex your chest muscles, a phenomenon called dynamic deformity. For many patients, this is a worthwhile exchange for a significantly lower chance of contracture recurring.
Using a Tissue Matrix
During revision surgery, some surgeons wrap the new implant pocket with acellular dermal matrix, a biological mesh made from donated tissue. This material acts as a scaffold that supports the pocket and appears to reduce contracture recurrence. It’s most commonly used in revision cases where contracture has already happened at least once. In published data, capsular contracture was the primary reason for using this material in 60% of cases, and the available evidence supports its role in minimizing repeat contracture.
Fat Grafting as a Preparation Step
For patients whose breast tissue has been damaged by radiation or repeated surgeries, fat grafting can help prepare the area before a new implant is placed. The technique, sometimes called “lipobed,” involves multiple sessions of injecting the patient’s own fat into the breast tissue to regenerate and soften it. In one comparative study, capsules that formed after this preparation were thinner (about 600 versus 670 micrometers) and contained significantly fewer of the contractile cells responsible for tightening. The fat-treated tissue also showed biological markers associated with healthier, more flexible scar formation.
This isn’t a standalone treatment for active contracture. It’s a conditioning strategy used over several sessions before implant replacement, particularly in difficult cases where the tissue environment needs restoration first.
Reducing Your Risk of Recurrence
Capsular contracture recurs in a meaningful percentage of patients after surgical correction, which is why surgeons often combine multiple strategies during revision. A typical approach might include total capsulectomy, switching to submuscular placement, using a tissue matrix, and choosing a textured or different-sized implant.
Factors that increase recurrence risk include subglandular placement, a history of hematoma or infection around the implant, and radiation therapy. If you’ve had contracture once, your surgeon will likely recommend the most aggressive combination of preventive measures rather than a single change. The goal is to address not just the current contracture but the conditions that allowed it to develop.
Post-surgery, following your surgeon’s instructions on compression garment use, activity restrictions, and any recommended massage protocol gives the new capsule the best chance of forming normally. Most patients return to full activity within several weeks, though the tissue continues to settle and soften for months afterward.