Capsular Contracture Treatment in Sarasota, FL
Fix a Breast Implant That's Gone Hard or Painful
Capsular contracture happens when the scar tissue your body naturally forms around a breast implant tightens and squeezes it. Everyone who has an implant forms a capsule. That's normal. The problem starts when the capsule contracts, which can make the breast feel firm, look round and high, sit differently than the other side, or hurt.
It's one of the most common reasons women need further surgery after augmentation, and it doesn't resolve on its own. Massage, medication, and waiting don't reverse an established contracture. Treatment means surgery to remove the tightened capsule.
Dr. Alissa Shulman has been a board-certified plastic surgeon since 2002 and is a Fellow of the American College of Surgeons (F.A.C.S.). She has practiced since 2000 and has been in Sarasota since 2009. She treats contracture regularly and will talk through whether you want to replace the implant afterward or take this as the moment to be done with implants entirely. Request an appointment to have it looked at.
Do You Have Capsular Contracture
Recognize the Signs and Know When to Come In
If one breast has become noticeably firmer than the other, changed shape, ridden higher on your chest, or started to ache, capsular contracture is the most likely explanation. Surgeons grade it on a four-point scale, and where you fall determines whether surgery is worth doing.
- Grade 1. The breast feels soft and looks normal. No treatment needed.
- Grade 2. Slightly firm to the touch but looks normal. Usually watched rather than operated on.
- Grade 3. Firm and visibly distorted, often sitting higher or rounder. Surgery is generally recommended.
- Grade 4. Firm, distorted, and painful. Surgery is recommended.
Contracture can appear within months of your original surgery or many years later. Risk is higher after a bleed or infection around the implant, and higher with textured implants.
Come in sooner rather than later if you notice a change. Hardening tends to progress, and a Grade 3 caught early is a more straightforward operation than a Grade 4 that's been ignored for two years. If you're unsure whether what you're feeling is normal, that's a reasonable thing to have checked.
What Happens, Step by Step
Follow Contracture Surgery From Diagnosis to Decision
Treating contracture is an outpatient operation, usually two to three hours under general anesthesia, meaning you're fully asleep. Length depends on how thick the capsule is and whether you're replacing the implant.
- Your consultation. Dr. Shulman examines both breasts, compares them, and grades the contracture. She'll ask when you noticed the change and how fast it progressed. Bring your implant device card if you have it, since implant age and type matter. She quotes you herself, and consultations run about 40 minutes.
- The decision that matters most. Removing the capsule is the surgical fix. The real question is what happens next. You can have a new implant placed, or you can have nothing placed and be done with implants. Dr. Shulman is an advocate for breast implant removal and will lay out both paths honestly, including the fact that contracture can recur with a replacement implant.
- The day of surgery. She works through your existing incision where possible. For an established contracture she removes the capsule, either partially or completely. Removing the capsule in one intact piece along with the implant is called a total capsulectomy, and it's the more thorough approach when the capsule is thick or calcified.
- Right after. You'll wake up in a surgical wrap. Most patients go home the same day with a driver. Drains are sometimes used after extensive capsule removal. The relief from the tightness and ache is often noticeable immediately.
Capsular Contracture Recovery
Plan Your Return to Normal After Capsule Surgery
Most patients return to desk work within about a week and to full exercise around four to six weeks. Recovery is generally easier than the original augmentation, though a total capsulectomy involves more dissection and takes longer to settle.
- The first week. Soreness and swelling, usually with immediate relief from the hard, tight sensation you came in with. You'll wear your surgical wrap day and night, and Dr. Shulman will tell you when to switch to a supportive bra. Any drains typically come out within the first week.
- Weeks two and three. Most desk workers are back. Swelling drops noticeably. No lifting anything heavier than a gallon of milk and nothing overhead.
- Weeks four through six. Activity builds back, with clearance for full exercise around four to six weeks depending on how extensive the capsule work was.
- Longer term. If you had a replacement implant placed, Dr. Shulman will discuss steps that may reduce the chance of contracture recurring. If you chose not to replace, your breast will continue settling over six to twelve months, and fat grafting is available later if you want some volume restored.
Risks Worth Understanding
Understand Recurrence and What Else Gets Checked
The honest limitation of contracture surgery is that it can come back. If you replace the implant, you accept some risk of the capsule tightening again, and that risk is higher for women who've already had one contracture. Choosing not to replace removes the risk entirely, which is part of why many patients use this as the moment to stop.
Surgical risks are the usual ones: bleeding, infection, fluid collection, changes in nipple sensation, and asymmetry. Because Dr. Shulman generally works through your existing incision, most patients don't gain new visible scars.
One thing worth knowing: persistent swelling or a fluid collection around an implant, particularly a textured one, is also evaluated for a rare cancer called breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). The Food and Drug Administration (FDA) requires this risk to appear in the boxed warning on implant labeling, and you can read its guidance on what to know about breast implants. It's uncommon, and it's the reason changes around an implant get properly assessed rather than assumed.
Paying for Contracture Treatment
Understand Cost and Whether Insurance Might Apply
Cost depends on how much capsule has to be removed, whether you're replacing the implant, and facility and anesthesia fees. A partial capsule removal sits below a total capsulectomy with a replacement implant.
Capsular contracture is one of the situations where insurance sometimes applies, since severe contracture and implant rupture can be considered medically necessary rather than cosmetic. Coverage varies by plan and approval isn't automatic. Sovereign Plastic Surgery bills insurance only for breast reconstruction after cancer surgery, so treatment here is self-pay regardless of what your plan might allow elsewhere. Dr. Shulman quotes you directly, and financing is available through CareCredit and Cherry. See our payment options and financing page.
Why Patients Choose Sovereign Plastic Surgery
Work With a Surgeon Who Lays Out Both Paths
Sovereign Plastic Surgery is a solo practice. Dr. Shulman runs your consultation, performs your surgery, quotes your price, and sees you at every follow-up. Patients can reach her directly afterward.
Contracture forces a decision: replace the implant or stop having implants. Plenty of surgeons present replacement as the obvious answer. Dr. Shulman, who both places implants and advocates for removing them, will genuinely walk you through both, including the recurrence risk that comes with replacing. Patients who've already been through one hardened implant often find that the more useful conversation.
You don't have to take our word for any of it. Patients describe their own results and their own care in their own words, and you can read reviews from Sovereign Plastic Surgery patients before you book.
About Your Surgeon
Meet the Surgeon Treating Your Contracture
Dr. Shulman has been a board-certified plastic surgeon since 2002, has practiced since 2000, and opened Sovereign Plastic Surgery in Sarasota in 2009. She was the first woman to serve as Chief of Surgery at Sarasota Memorial Hospital, next door to her office, and the only plastic surgeon ever appointed Chief of Staff there. Because she performs augmentation, revision, and explant, she sees the full arc of what happens to implants over decades. She works below the neck only. Read Dr. Shulman's full background and credentials.
Frequently Asked Questions
The earliest sign is usually one breast feeling firmer than the other. As it progresses, the breast may look rounder, sit higher on the chest, change shape visibly, or become painful. It often affects one side only, which is why comparing the two is the simplest home check.
Surgery is the only reliable treatment for an established contracture. Dr. Shulman removes the tightened capsule, partially or completely, along with the implant. You then decide whether to have a new implant placed or to leave them out. Massage and medication don't reverse a contracture once it's formed.
A total capsulectomy means removing the entire capsule of scar tissue rather than only part of it. When the capsule comes out in one intact piece with the implant still inside, that's called an en bloc capsulectomy. It's the more thorough approach and is generally used when the capsule is thick, calcified, or badly contracted.
Not every explant needs one. A thin, soft, healthy capsule can sometimes be safely left in place. Capsule removal is indicated when it's thickened, calcified, contracted, or when there's been a rupture. Dr. Shulman will explain which applies to you rather than defaulting to the most aggressive option.
It depends on the type. A saline implant deflates visibly within days and your body harmlessly absorbs the salt water. A silicone rupture is often silent, with the gel staying inside the capsule, which is why imaging surveillance is recommended for silicone. Either way, a ruptured implant should be removed.
Scheduling is easy. You can request an appointment online or call the office at 941-366-5476, and the team will call you back to confirm a time. You'll meet Dr. Shulman herself. We look forward to seeing you.