If your breast implant feels firm, aches, or appears deformed, you could be suffering from capsular contracture.

Capsular contracture occurs when the fibrous scar tissue (the capsule) that usually forms around the implant becomes contracted and compresses the implant. This can produce discomfort and change the appearance of the breast.

Capsular contracture may be treated conservatively with non-surgical methods or surgically through a corrective operation based on the degree of contraction.

We’ll go over what to look for in terms of signs, who’s at risk, the various non-surgical and surgical treatment options available, and how to minimize and treat the recovery and potential prevention of this issue to develop a solid plan with Dr. David A. Newman and our staff.

If you think you may have capsular contracture and are in the Temecula area, contact Newman Plastic Surgery for a case consultation. 

What is Capsular Contracture?

Capsular contracture is when the fibrous scar tissue surrounding a breast implant (capsule) becomes contracted and compresses the implant. Normally, your body forms a thin layer of fibrous scar tissue called a capsule to encapsulate any foreign object, including a breast implant. However, when the capsule becomes thickened and contracts, it can cause discomfort and change the appearance of the breast. You may notice that one breast is firmer than previously or that both are uneven. Firmness can vary from a mild tightness to a completely firm, misshapen breast. Discomfort or pain may occur due to the tight capsule.

Capsular contracture can alter the implant position, shape, and the overall appearance of the breast.

How Does Capsular Contracture Occur and Why?

Capsular contracture begins with inflammation around the implant. The most common causes of inflammation are contamination by bacteria that occurred either during or after surgery, postoperative bleeding, or minor repeated injuries to the area. The body reacts by creating more fibrous scar tissue, and, in some cases, contracting it.

Risk factors for developing capsular contracture include:

1. Implants placed above the muscle
2. Smooth-surface implants
3. Smoking
4. Radiation therapy to the chest
5. Infection

Infection is the primary cause. Even small levels of bacteria can continue to inflame the area chronically. An individual’s healing response plays a role in their ability to form thickened scars.

Symptoms to Look Out For

Watch for changes in firmness, shape, and pain. Mild contracture may present itself as a slight, early tightening or change in the breast shape. Severe contracture may cause the breasts to appear rounded, higher, or unbalanced.

Some common symptoms include:

• Increasing firmness or hardness of the breast
• Visible changes or irregularities in the shape of the breast
• Pain, tenderness, or discomfort, especially with compression
• The implant feels higher or pushed towards the middle of the breast

If you experience persistent firmness, worsening symmetry, or pain, schedule an appointment with our office immediately. Identifying symptoms earlier in the process allows for greater options in treatment and helps prevent further progression.

Risk Factors for Developing Capsular Contracture

Some of the risks for developing capsular contracture include medical histories, types of implants, and individual healing responses.

Smoking, radiation therapy, contamination of the implant with bacteria, the type of implant, and the location of the implant all contribute to the development of capsular contracture.

Common Risk Factors

Radiation therapy to the chest can damage tissues and stimulate chronic inflammation around the implant. Smoking also restricts blood flow and slows down the healing process, which promotes scarring.

Even tiny amounts of bacteria on the implant can start a cycle of chronic inflammation. Bacteria can grow in the initial fluid or blood that develops around the implant in the early post-operative period. If you are prone to repeated infections or have a tendency to form dense scars, you are at increased risk of developing contracture.

Implant Surface Types Matter

Smooth-surface implants pose a different level of risk than textured implants. Larger implants or those positioned directly under the muscle (subglandular) can exert greater pressure on the capsule and increase the likelihood of it becoming contracted.

How Surgeon Techniques Influence Risk

Your surgeon’s techniques affect the prevention of infection and tissue trauma. Maintaining strict sterility, gently managing the implant, and limiting the amount of time spent in the operating room can significantly reduce the amount of bacteria transferred to the implant and subsequently reduce the risk of developing contracture.

The placement of the implant also influences the risk of developing contracture. Generally, the submuscular (under the pectoralis muscle) placement of the implant reduces the risk of contracture compared to subglandular placement. The muscle provides additional protection and reduces direct pressure on the capsule.

Additional Choices That Influence Risk Include:

Incision Site – Whether a sleeve or irrigation solution was used during the implantation process

Gentle tissue dissection, controlling hemorrhage to minimize the amount of bleeding around the implant, and the use of an antimicrobial wash can all reduce the number of triggers that can lead to contracture.

Treatment Options for Capsular Contracture

Both non-surgical and surgical methods exist for treating capsular contracture. Both options are designed to alleviate pain, soften the breast, and restore its original shape. Depending on the degree of the symptoms, Baker Grade, and personal preferences, you can select one method or combine both.

Conservative Measures

Conservative measures can be effective in treating mild to moderate cases of contracture and may delay the necessity for surgery. Medications such as anti-inflammatory agents can provide relief from pain and swelling. Other non-surgical methods include targeted massage and ultrasound therapy to soften the capsule. While massage and ultrasound may be beneficial when implemented early, they can rarely reverse firm, advanced contractures. Some clinics provide device-based treatments (such as external ultrasound or massage devices) to reduce the tightness of the capsule; anticipate moderate success and possible repeat sessions.

Provide your surgeon with information regarding any signs of infection. If a cause such as a low-grade infection or seroma is detected, antibiotics or drainage may be necessary prior to initiating any other treatments.

Surgical Alternatives

Surgery is the most reliable method to correct moderate to severe contracture or when symptoms do not improve. Commonly performed surgical alternatives for correcting contracture include:

Capsulotomy – the surgeon opens and cuts into the capsule to release the tension.

Capsulectomy – partial or complete removal of the scar tissue that has become hardened.
Exchange of Implant – replacement of the current implant, commonly with an alternative type or positioning.

Based upon your case, your surgeon may elect to move the implant pocket from subglandular to submuscular, utilize textured or smooth-surfaced implants, or apply an acellular dermal matrix to minimize recurrence. Surgery, however, carries risks including bleeding, infection, anesthetic complications, and recurrence of contracture. Recovery and follow-up appointments are generally required and vary, but typically include restrictions on activity and follow-up appointments to assess healing.

Determining Which Treatment Option Works Best for You

Determine your treatment options based upon your symptoms, the age of your implant(s), and your cosmetic objectives. Non-surgical methods may be considered reasonable to attempt initially if your breast feels only slightly firmer and/or you experience minimal pain. If you suffer from pain, noticeable distortion, or a Baker Grade III-IV contracture, surgery will likely provide the most favorable long term results.

Consult with Dr. David A. Newman at our clinic to determine specifics including expected outcomes, the location of your scars, implant options, and the risk of recurrence. Ask about utilizing imaging (MRI or ultrasound) to assess the integrity of the implant(s) and to determine if any infection or rupture is occurring. Create a written plan outlining the procedural steps, anticipated recovery timeline, and follow-up care to ensure you understand what to expect.

Recovery and Prevention

Recovery from surgery is generally brief, followed by a series of strategies to minimize the risk of recurrence of capsular contracture. Expect to follow a regimen of wound care, limited activity, and follow-up appointments to identify any problems early-on and protect your results.

Post-Surgical Care

Following surgery, you will have dressings and possibly drains that are removed within 24-48 hours. You may experience a period of tightness, bruising, and soreness that reaches its peak in the first week and continues to improve until two to six weeks post-operatively.

Your surgeon will provide you with a specific timeline: when to remove your dressings, when to remove your drain(s) (if applicable), and when to return for suture removal and examinations.

Activity Restrictions

Limiting your physical activity is important. For four to six weeks post-operatively, avoid heavy lifting, bending, or any exercise that strains the chest muscles. Gradually return to normal activities as directed by your surgeon. Wear the recommended post-operative supportive garments or bras to control swelling and support the implant position.

Be aware of warning signs that require immediate attention from the office: increasing pain, redness, fever, sudden firmness of the breast, or unusual drainage. Contact the office as soon as you experience any of these symptoms. Prompt treatment will decrease the risk of complications and may reduce the need for future surgery.

Ways to Decrease the Likelihood of Reoccurrence

Adhere strictly to the instructions provided for preventing infection: take any antibiotics that were prescribed, maintain the cleanliness and dryness of your incisions, and refrain from touching the areas with unwashed hands. Infection and chronic inflammation are major contributors to the risk of developing contracture.

Avoid smoking and the use of nicotine products for at least four-six weeks pre-operatively and post-operatively. Nicotine can slow the healing process and promote scarring.

Attend all scheduled follow-up appointments to allow Dr. David A. Newman to evaluate the formation of the capsule early. If Dr. Newman identifies any evidence of early tightening, non-surgical interventions such as massage (as directed), ultrasound, or medications may be effective.

During breast implant revision surgery, the choices that can minimize recurrence include capsulectomy or capsulotomy, converting the implant pocket from subglandular to submuscular, using textured or smooth-surfaced implants selectively, and applying an acellular dermal matrix. Discuss the risks and benefits with the staff to develop a plan tailored to your specific situation.

After breast implant removal, you will likely experience more looseness and reduced fullness. However, the extent to which your breasts will sag after explant will depend on your skin, the size of the implants, and how long they were in your body. The majority of women will experience some degree of sagging after implant removal, and most will elect to undergo a breast lift or another procedure to reshape and lift their breasts simultaneously.

This post will address how removing the implants changes the overall breast shape and the expected changes, as opposed to the amount of actual sagging experienced by patients. We will also discuss options available to restore shape and volume to your breasts. By the end, you will understand the various ways to determine if you should plan for a breast lift, the possibility of utilizing fat grafting or just waiting for your body to heal prior to undergoing additional surgery.

How Implant Removal Affects Breast Shape

Once an implant is removed, there will be a loss of volume, skin elasticity will decrease due to the loss of support from the implant, and the position of the tissue will change. Typically your breasts will be smaller, less full on the upper portion, and the skin will be looser or hang differently than it did prior to the removal of the implants based upon multiple factors.

What Happens to Breasts Once They Have Had an Implant Removed

After an implant is removed the skin and breast tissue lose the support and the stretching caused by the implant. Generally, you will have less fullness on the upper pole of the breast and the contours will be softer and flatter in the area where the implant was located. The nipple(s) will generally sit lower on the breast mound and will likely point downward since the skin has stretched.

The internal structures that supported the implant (such as the pocket and the capsule) may either collapse or tighten. Additionally, the scarring from the implant pocket can affect the overall shape. There will be some areas where the tissue will settle within days and some areas where the tissue will take months to soften and become positioned again. If you wish to achieve more lift or volume, you can opt for a mastopexy (breast lift) or fat transfer — both are common options.

Factors That Determine the Amount of Sagging After Removal

Age affects skin elasticity; as you get older, your skin has less recoil, therefore it tends to sag more easily. Similarly, the size of the implants and how long they have been in your body are important factors as well — larger implants and longer periods of time in your body result in greater stretch. Additionally, your original breast size and the quality of the connective tissue in your breasts will influence how well your breasts bounce back.

Other factors, such as smoking, having children, gaining or losing weight, or having prior surgeries, can all affect the elasticity of your skin and the quality of your tissue. Likewise, the location of the pocket (under muscle vs. under muscle) and the existence of capsular contracture can affect the final shape of your breasts post-removal. It is essential to share your medical history with Dr. David A. Newman so he can advise you on what to expect and what corrective measures would be advisable.

Temporary Changes vs. Permanent Results

Generally, in the short term, you can anticipate swelling, bruising, and increased firmness resulting from the surgery. Within the first 6 – 12 weeks, your breasts will appear smaller and possibly sit higher or in odd positions as the tissues adjust. Your sensation and firmness may also change and ultimately stabilize as the tissues continue to heal.

It is generally within 6 – 12 months post-surgery that the final results will appear. By that time, the tissue will have settled, and the scars will have matured. While some patients may permanently experience sagging or looseness that cannot be corrected without a lift, others may end up with a soft and natural-looking shape due to the elasticity of their skin and the fact that they had small implants. If you desire to achieve a consistent shape and projection after removal, consult with the Newman Plastic Surgery team regarding combining explant with a lift or fat grafting at the time of removal.

Indicators of Sagging Post Explant Surgery

Some of the indicators of sagging post-explant surgery may be less fullness, a nipple that is lower than normal or excessive loose skin. While some of these changes are temporary and will occur during the healing process, others may be permanent if the skin and tissue no longer have sufficient elastic properties to “bounce back” into their original shape.

Identifying Sagging

Identify sagging by looking for drooping of the nipple to below the inframammary fold. One or both nipples pointing downward or being positioned lower than in previous surgery indicates sagging (ptosis). Check for loose or excess skin that causes a folding or wrinkling effect when leaning forward. Compare the two sides. When standing in front of a mirror with your arms at your side, compare the nipple heights, the amount of breast tissue hanging below the inframammary fold, and the general appearance of deflation. Photographs taken before and after explant may demonstrate changes more clearly than memory.

Healing vs. Sagging

Within the first three to six months post-explant surgery, swelling, tissue settling, and skin stretching can create uneven or sloppy appearing breasts. Wearing supportive bras and compressive garments can assist with improving appearance while the skin continues to tighten. Mild asymmetry and tenderness are common and often resolve as time passes.

If, after six to twelve months, the nipple remains below the inframammary fold, or if the skin hangs with a distinct shelf, it is likely a result of a permanent change. Factors that contribute to permanent sagging include large implant sizes, low skin elasticity, pregnancy, and advanced age. If you desire improvement, options include a mastopexy (breast lift), fat grafting, or replacing the implants with smaller ones. Discuss these options with Dr. David A. Newman at our office so you can develop a customized treatment plan based upon your individual anatomical characteristics.

Options for Improving Breast Appearance Post-Explant

You can choose to pursue either surgical or non-surgical methods to enhance shape, lift, or volume. Your skin quality, the length of time you had the implants in place, and your desired outcome will help identify the most suitable method for achieving the results you want.

Breast Lift Options

A breast lift (mastopexy) removes extra skin, repositions the breast tissue and nipple to a higher, more firm position. Depending on how much lift you require, surgeons frequently utilize a variety of techniques including vertical, crescent, and/or anchor incisions. If you had large implants or had the implants for extended periods of time, you may require additional skin to be removed to prevent excessive sagging after the implants have been removed.

You can also elect to perform a lift in combination with fat grafting if you want to restore a more natural fullness to your breasts without the use of new implants. Performing both procedures concurrently may extend the duration of your surgery and subsequent recovery, however, it may produce a more symmetrical shape and projection. Discuss scar patterns, anticipated nipple positioning and achievable projection for your specific anatomy.

Non-Surgical Methods

While non-surgical alternatives may offer some benefit, none will significantly reverse sagging. Fat transfer is one alternative and allows you to utilize your own fat to plump areas of your breasts; however, it typically produces less lift than an implant. Injectable fillers are rarely utilized for breast augmentation and provide minimal, temporary change. Compression garments, supportive bras, and localized physical therapy may aid in enhancing the appearance of your breasts while you heal. Radio frequency and/or laser treatments may help improve mild skin laxity, but will be far less dramatic than surgery. Discuss realistic outcomes so that your expectations align with the potential benefits offered by each option.

Individualized Attention and Treatment Options at Newman Plastic Surgery

Newman Plastic Surgery reviews your implant history, breast tissue, and skin elasticity to recommend the most beneficial course of action. You will meet with our team to discuss the different lift types, the feasibility of using fat grafting, incision locations, and the steps required for recovery.

If you are planning to remove your implants, contact us to set up a consultation to discuss the options that best fit your needs and lifestyle: https://temecula-plastic-surgery.com/breast-implant-removal/.

Our team provides pre-operative photographs, demonstrates the anticipated scar map, and outlines a recovery timeline, so you know what to expect. Our staff arranges follow-up appointments to assess your healing progress and provide support, such as garments or scar management.

Choosing between saline and silicone breast implants can feel overwhelming, but you can make a clear choice when you focus on what matters most to your body and goals. Pick saline if you want an implant that shows a rupture right away and costs less; pick silicone if you want a more natural feel and are okay with regular imaging to check for silent ruptures.

You will learn how each implant looks and feels, what health and age rules apply, how long implants typically last, and which risks and benefits matter for your lifestyle. Talk with our team at Newman Plastic Surgery about your anatomy, budget, and aesthetic goals so you leave the consult confident about your next steps. Contact us today!

Understanding Saline and Silicone Implants

You’ll learn what fills each implant, how they feel, and key maintenance or safety differences. This helps you match an implant to your body, goals, and lifestyle.

How Saline Implants Work

Saline implants have a silicone shell filled with sterile salt water (saline) after the shell is placed in your breast. Surgeons can insert an empty shell through a smaller incision, then fill it to the precise size during surgery. That lets the surgeon make minor volume adjustments while you’re still in the operating room.

If a saline implant ruptures, the saline leaks out and your body absorbs it safely, and you’ll notice an obvious change in breast shape. Saline implants tend to feel firmer and show rippling more easily, especially if you have thin breast tissue. They often cost less than silicone and are available in smooth or textured shells.

How Silicone Implants Work

Silicone implants use a silicone shell filled with cohesive silicone gel designed to mimic the feel of natural breast tissue. The gel varies by cohesiveness; newer “gummy bear” types hold shape better and feel firmer in certain areas while still feeling soft overall. Surgeons usually insert silicone implants prefilled, so the incision may be slightly larger than for saline.

A silicone rupture may not cause obvious shape change; your surgeon will recommend periodic imaging (usually MRI or ultrasound) to check for silent ruptures. Silicone implants often look and feel more natural than saline, particularly for patients with less native breast tissue.

Common Features and Differences

• Fill: Saline = sterile salt water, Silicone = cohesive silicone gel.
• Incisions: Saline can use smaller incisions because it’s filled after placement; silicone often needs a larger incision for a prefilled implant.
• Feel and appearance: Silicone usually feels softer and more natural; saline may feel firmer and show rippling if your tissue is thin.
• Rupture detection: Saline ruptures are visible immediately; silicone ruptures can be silent and need imaging to detect.
• Cost and options: Saline implants are generally less expensive; silicone offers more gel types (including form-stable options).
• Safety and regulation: Both types use a silicone elastomer shell and are FDA-approved devices; risks and follow-up needs differ mainly by rupture behavior and imaging needs.

If you want, we can go over which points matter most for your body type and goals.

Factors to Consider When Choosing Implants

You should weigh how the implants will look on your body, how they will feel, the surgical approach, and any age or health rules that affect safety and results. These points help you pick the type, size, and placement that match your goals and lifestyle.

Aesthetic Goals and Natural Look

Decide what you want your final shape to be. If you want a fuller, rounder upper breast, silicone implants often give a smoother, more natural slope. Saline implants can also look good, but they may show rippling more in thin tissue.

Think about size, projection, and how the implant sits on your chest. A photograph of breasts you like helps your surgeon know your target. You’ll also discuss placement: under the muscle often looks more natural in thinner patients, while over the muscle can give more lift but may show edges.

Bring realistic expectations. Your body type, skin elasticity, and existing breast tissue limit how large you can go without complications. At Newman Plastic Surgery, we measure your chest and try on sizers so you see possible outcomes before deciding.

Feel and Texture of Implants

Silicone implants tend to feel closer to natural breast tissue because of their cohesive gel fill. Many patients report a softer, more natural touch, especially with moderate or larger sizes.

Saline implants are filled with sterile salt water and can feel firmer or less natural in thin patients. They do offer a smaller incision since they’re inserted empty and then filled, which some patients prefer.

Surface texture matters too. Smooth implants move more naturally in the pocket. Textured implants aim to reduce movement but have specific risks to discuss with Dr. Newman. Ask about gel cohesiveness, shell thickness, and how each type behaves with your body type.

Incision Options and Surgical Techniques

Your incision affects scarring, implant placement, and recovery. Common incision sites include inframammary (under the breast fold), periareolar (around the nipple), and transaxillary (in the armpit). Each has pros and cons for visibility and access.

Inframammary gives the most direct access and precise pocket control. Periareolar can hide scars along the nipple edge but may carry a higher risk of affecting nipple sensation. Transaxillary avoids breast scars but can limit placement options.

Decide on submuscular (under the pectoral muscle) versus subglandular (over the muscle) placement. Submuscular placement can reduce visible rippling and mammogram interference. Subglandular can give a stronger upper pole fullness but may show edges if tissue is thin.

Age and Health Requirements

You must meet FDA age and health guidelines. For saline implants, FDA approval starts at 18 years. For silicone implants, FDA approval typically starts at 22 years for cosmetic augmentation. These ages help ensure physical maturity.

Your overall health matters. Smoking, uncontrolled diabetes, certain autoimmune conditions, or a high body-mass index can increase surgical and healing risks. You’ll need a full medical history, current medications, and possibly lab tests before surgery.

Plan for screenings and follow-up. Silicone implants often require periodic MRI or ultrasound checks for silent rupture. Saline ruptures are obvious because the implant deflates. Discuss routine monitoring and long-term care with our team so you know what follow-up looks like.

Risks, Benefits, and Longevity

You’ll weigh safety, recovery, and how long implants last when choosing. Think about rupture risk, feel and appearance, follow-up needs, and likely timelines for replacement.

Safety and Potential Complications

Both saline and silicone implants carry risks like infection, bleeding, scarring, and capsular contracture (hardening around the implant). Silicone gel can cause a silent rupture that may not show symptoms, so imaging (MRI or ultrasound) is recommended periodically. Saline ruptures are obvious because the implant deflates, and the saline is harmlessly absorbed by your body.

You also face risks from surgery itself: anesthesia reaction, poor wound healing, and asymmetry. Implants can affect mammogram images, so you’ll need specialized views and to inform your radiologist about your implants. Rarely, textured implants have been linked to a lymphoma (BIA-ALCL); discuss implant surface type with your surgeon.

Recovery Experience and Maintenance

Initial recovery usually takes 1–2 weeks for basic activity, with more strenuous exercise cleared after 4–6 weeks. Pain and swelling are common the first week; you’ll use pain meds, wear a support bra, and follow wound care instructions. Silicone implants often feel more natural and may have less visible rippling, which can reduce the need for early revision for cosmetic reasons.

Maintenance differs: silicone users need periodic imaging (MRI every 3–5 years is often suggested) to check for silent rupture. Saline users don’t need routine imaging for rupture but should monitor shape and firmness. Both types require regular follow-up visits; if you notice changes in size, shape, pain, or firmness, contact the clinic promptly.

Expected Lifespan of Each Type

Implants are not lifetime devices. Many patients keep implants 10–20 years before replacement or removal, but individual results vary. Silent silicone ruptures can occur sooner, which is why imaging matters; saline ruptures are detected immediately and typically corrected when they happen.

Common reasons for replacement include rupture, capsular contracture, cosmetic changes, or implant aging. Revision rates rise with time, so plan for possible future surgery. At Newman Plastic Surgery, we help you track your implants and schedule checks so you know when intervention might be needed.

Personal Consultation and Next Steps

A one-on-one visit helps match implant type to your body, goals, and lifestyle. You will review risks, recovery, and follow-up plans so you leave with a clear, personalized plan.

Why Individualized Guidance Matters

Your chest shape, skin thickness, and daily activities affect whether saline or silicone fits you best. For example, if you have little natural breast tissue, a silicone implant often gives a more natural contour, while saline can allow for smaller incisions and adjustable fill during surgery.

We also consider long-term needs like mammogram compatibility and routine monitoring. Silicone implants usually require periodic imaging to check for silent rupture; saline ruptures are obvious right away. Cost and warranty differences matter too—ask about implant lifetime coverage and revision policies at Newman Plastic Surgery.

What to Expect During Your Consultation

Expect a 45–60 minute visit with our patient coordinator and Dr. David A. Newman. We begin with medical history, prior surgeries, and current medications. Then Dr. Newman examines your chest, measures breast width and skin laxity, and discusses realistic size options.

You’ll review implant styles (shape, profile, texture), incision sites, and placement (above or below the muscle). We’ll show photos of real patient results and use sizing tools so you can visualize outcomes. Finally, our team outlines the surgical plan, anesthesia, recovery timeline, and cost estimate.

Questions to Ask Dr. Newman

Prepare a short list so you cover safety, results, and recovery. Useful questions include:

• Which implant type and size do you recommend for my goals and why?
• Will implants be placed above or below the muscle for my body?
• What incision location gives the best scar and result for me?
• What are the specific risks and how often do complications occur in your practice?
• What is the expected recovery timeline and activity restrictions?
• How do you handle implant rupture, capsular contracture, or revision surgery?
• What are total costs, financing options, and warranty coverage?

Bring photos of looks you like and a list of medications. That helps Dr. Newman give precise, tailored advice for your best outcome.

Ready to book your consult?

Contact us today to schedule an appointment to discuss a breast augmentation procedure with Dr. Newman.