Capsular Contracture Treatment in Beverly Hills & Los Angeles
A complete, root-cause repair for hard, painful or distorted breast implants with Dr. Kelly Killeen
Schedule Consultation
When the scar tissue around a breast implant tightens, the implant can become hard, painful or distorted. This is called capsular contracture, and a true contracture is treated with surgery.
Contracture is one of Dr. Kelly Killeen's favorite problems to solve in her Beverly Hills practice. Her approach goes after the likely causes, not just the symptoms, and she is open about its trade-offs.
"You deserve soft, non-painful breasts. You deserve to feel comfortable in your own body."
Dr. Killeen is double board-certified (American Board of Surgery and American Board of Plastic Surgery) and counts capsular contracture management among her core specialties. She also teaches other plastic surgeons about it, including her talk "Hidden Pitfalls of Contracture Management" at the American Society for Aesthetic Plastic Surgery meeting in May 2026.
Capsular Contracture Treatment in Beverly Hills, Los Angeles & Beyond
Dr. Killeen treats contracture patients from across the greater Los Angeles area, including West Hollywood, Santa Monica, Brentwood, Bel Air, Pasadena, Calabasas and Sherman Oaks, as well as patients from elsewhere in California and out of state. Many come for a second opinion.
Complicated revision surgery is a large part of her practice, including for patients whose first surgery was done abroad, where operative records are often hard to get.
For patients traveling from outside the LA area, the team helps coordinate scheduling, recommended recovery accommodations nearby, and post-operative follow-up so the experience feels seamless from consultation through final result.
Capsular Contracture Treatment at a Glance
- Procedure type
- Revision surgery for Baker grade III and IV capsular contracture
- Techniques
- Complete capsulectomy, biofilm testing, a brand-new implant or removal, and a scaffold or pocket change when needed
- Surgery length
- Varies with complexity
- Anesthesia
- Your anesthesia plan is reviewed at your consultation
- Recovery time
- Typically about 1 week before desk work and about 1 month before full activity; your timeline is confirmed at consultation
- Insurance
- Sometimes partly covered for severe contracture, even with cosmetic implants
- Customization
- Every plan is tailored to your implant history, anatomy and goals
What Is Capsular Contracture?
Your body walls off any implanted device, from a pacemaker to a breast implant, with a capsule made of your own collagen. A normal capsule is thin and soft, and it even acts a bit like an internal bra, giving the implant a second layer of support. The capsule forms in about 6 weeks and typically matures 3 to 6 months after surgery.
Capsular contracture happens when chronic inflammation makes that capsule abnormally thick and tight. It squeezes the implant, causing firmness, visible distortion or pain, and it can squeeze hard enough to leave an intact implant permanently dented or folded. The capsule is not the implant's shell: the shell is part of the implant, while the capsule is tissue your body made. Learn more about the causes and prevention of capsular contracture.
Contracture usually develops gradually over months or years, so many patients do not notice it at first. It can affect one breast or both. A contracture caught before it becomes severe is generally an easier, less expensive operation, which is why regular exams matter.
Signs and Baker Grades of Capsular Contracture
Contracture is progressive. It often starts with an implant that feels firmer but still looks normal, and it can progress to a visibly distorted, painful breast. Some firmness in the first weeks after surgery is expected; learn how long implants take to soften.
- A breast that feels firm or hard
- An implant that looks too round, sits high or looks distorted
- One breast that now looks or feels different from the other
- A nipple that is no longer centered over the implant
- A squeezing or aching pain, which is common but not always present
- Discomfort hugging, lying on your stomach, or doing yoga or Pilates
- Firmness that returns after the breast had started to soften
- A slow change over months or years, even long after surgery
Surgeons grade capsular contracture on the Baker scale:
Baker Grade I
Soft and natural looking (a normal capsule, not a contracture)
Baker Grade II
A little firm, but the breast looks normal
Baker Grade IIIMay need surgery
Firm and abnormal looking, though not always painful
Baker Grade IVMay need surgery
Hard, painful and abnormal looking
Grades III and IV are the ones that may need surgery. In Dr. Killeen's view, you either have a contracture or you don't, and a true contracture is a surgical problem. What gets called a "mild contracture" is sometimes an implant riding high in a tight pocket, which is treated differently, as a breast revision.
Read more about mild contracture and when implants can be reused.
What Causes Capsular Contracture?
In Dr. Killeen's experience, the two most common causes are biofilm and ruptured silicone. A hematoma (a collection of blood around the implant), especially one that is not drained, is a secondary risk factor.
Biofilm
Ruptured Silicone
Hematoma
Other Risk Factors
- An incision around the nipple or in the armpit, which in Dr. Killeen's view carries more contracture and infection risk than one in the breast crease, though studies are mixed (see incision options)
- Older saline implants placed from 1992 to 2006, when silicone implants were largely off the US market, which in Dr. Killeen's experience have high contracture rates
- Very large implants for your frame
- Radiation, which stiffens tissue and raises contracture risk
- Mastitis (a breast infection, often during breastfeeding) that is not treated quickly or is hard to treat
- An infected nipple piercing, since bacteria can travel through the ducts
- Inflammation around the implant from fat necrosis (fat tissue that has died and hardened) or fluid, even without bacteria
An early capsular contracture, in the first months after surgery, has the same possible causes but a different likely culprit. Rupture is almost never to blame this early. Hematoma and biofilm are more likely, often after redness, drainage or a fluid collection that was treated with antibiotics.
How Capsular Contracture Is Diagnosed
Diagnosis starts with a hands-on exam by a plastic surgeon. Contracture has to be ruled in or out before any other implant position problem is treated, because its treatment is completely different.
A Hands-On Exam
A normal implant should always feel soft. Your plastic surgeon compares both breasts by feel and position. Your primary care doctor, gynecologist and breast surgeon should also note how your implants feel at every visit, so small changes are caught over time.
Healing, Tight Muscle or Contracture?
Firmness that is equal on both sides and gradually easing in weeks 2 to 6 is usually normal healing. A tight muscle holds an implant high and firm right after surgery, then it softens and drops. A contracture usually looks good at first, then gets firmer and higher starting around 6 to 8 weeks. An implant that stays high or keeps rising needs your surgeon's exam (see implants too high after surgery).
Imaging Before Any Revision
If you have silicone implants, get an ultrasound, MRI or other rupture screening before any revision. A rupture can change the operation and may qualify for insurance coverage, even with cosmetic implants. Biofilm cannot be seen on imaging, so it is tested during surgery.
Screening for Breast Cancer
Keep up your breast cancer screening. Mammograms are still recommended with a contracture. If compression is too painful, Dr. Killeen usually recommends a screening ultrasound instead, and a contracture that painful is a sign it should be treated.
Loading before & after results...
Why Contracture Repair Needs to Be Done Right the First Time
Many of Dr. Killeen's contracture patients have already had one or more repairs, or were told to simply live with it. When she reviews their records, two patterns come up often: the old implant was put back in, or the right steps were done piecemeal across different surgeries, never all at once.
"When you treat contractures, you can't skimp on anything. You just need to do all of the things."
That is why every step of her protocol happens in a single operation. Surgeons still debate the best approach, and no randomized trial has compared the methods directly, so your examining surgeon's advice matters. But if you have been told your contracture cannot be treated, consider getting another opinion. Read more about how contracture should be treated.
Non-Surgical Treatment: What Helps and What Doesn't
A true contracture is a surgical problem. Some options may slow an early contracture while you wait for surgery, but they are unlikely to reverse one that is established. If you are not ready for surgery, keep regular follow-up visits so changes are tracked.
Medications
Vitamin E and certain asthma medications (leukotriene inhibitors such as montelukast or zafirlukast) are sometimes tried for an early contracture while surgery has to wait. They are off-label for contracture and the evidence is limited. Dr. Killeen is skeptical but considers them reasonable to try in that window.
Safety note: Each carries its own risks: high-dose vitamin E can increase bleeding, montelukast has an FDA boxed warning for serious mental health side effects, and zafirlukast carries a warning for rare but serious liver injury. Tell your surgeon about any medications or supplements before surgery.
Ultrasound Devices
External ultrasound devices are marketed to soften contractures. Dr. Killeen does not believe they treat contracture: early firmness often softens on its own, which can make a device look like it worked, and there is no good study showing a benefit.
Massage
Implant massage is often suggested, but the research does not support it as a way to prevent or treat contracture.
Closed Capsulotomy
Squeezing the breast by hand to break the capsule should never be done. Implant labeling warns against it because it can rupture the implant or cause bleeding.
Benefits of Capsular Contracture Surgery
The goal is simple: a breast that looks and feels natural again, without the daily discomfort.
Physical Benefits
- A softer feel: The goal is an implant that feels soft again
- Less squeezing pain: Removing the thick, tight capsule targets the source of the pain
- Better shape and position: The implant can sit where it belongs instead of riding high
- Everyday comfort: The goal is easier hugging, lying on your stomach, yoga and Pilates
- A fresh start: A brand-new implant, or removal if you prefer
Emotional and Lifestyle Benefits
- No more "just living with it": A chronic problem treated instead of ignored
- Confidence in clothes: Comfort in swimwear, fitted tops and at the gym
- Clear answers: A diagnosis and plan you understand, trade-offs included
- Peace of mind: Implants cared for as the medical devices they are
- At home in your body: Feeling comfortable in your own skin again
How Dr. Killeen Treats Capsular Contracture
Fixing a contracture can be challenging, but it can be done. Dr. Killeen's protocol targets the capsule, bacteria and any ruptured silicone, and it is tailored to whether you want to keep your implants, change their size or position, or remove them.
Complete Capsulectomy
For a Baker III or IV contracture, Dr. Killeen removes the entire capsule, including the back wall against the chest. Some surgeons remove only part of it or build a new pocket instead, and she is open that this is debated.
"I am in the camp of total capsule removal."
An abnormal capsule left behind can keep causing pain, hardness and distortion, sometimes even after the implant is out. After a silicone rupture, she prefers to remove the capsule even when it looks soft, because how it looks during surgery can be misleading. A good capsulectomy takes as little surrounding tissue as possible. Read more on when the capsule needs to come out.
Capsulectomy is not free of risk. In a large insurance database study, adding a capsulectomy about doubled the rate of major complications, mainly bleeding (hematoma), although the overall risk stays low.
The terms matter. A capsulotomy only cuts or releases the capsule and leaves it in place. A complete (total) capsulectomy removes the whole capsule. A total intact capsulectomy removes the implant and capsule together in one piece, which helps with older ruptured silicone or calcified capsules. An en bloc capsulectomy also removes a rim of normal tissue and is only for documented capsule cancer. See the types of implant removal.
Testing and Treating Biofilm
Standard cultures around implants often miss biofilm, so Dr. Killeen sends a DNA-based (PCR) bacterial test during surgery. After the capsule is out, she cleans the pocket with pulse lavage, which she compares to a medical power wash. Gloves and instruments that touched the old capsule are then swapped, so the rest of the operation is done in a clean field.
A Brand-New Implant, or No Implant
If you are keeping implants, you always get a brand-new implant. Bacteria on the old implant cannot be cleaned off in the operating room, and reusing a single-use device is off-label. The repair can be combined with a size or profile change, a lift, or a move above the muscle.
Not sure you still want implants? In Dr. Killeen's view, removal is never wrong, and implants can go back in later. Having already had one complication does raise the risk of future problems if you replace the implant. Read how to weigh replacing or removing your implants.
If only one side is affected, Dr. Killeen talks through whether to operate on one side or both.
Scaffolds: Dermal Matrix or Absorbable Mesh
A scaffold is a thin sheet of human dermal matrix or absorbable mesh placed in the pocket. Dr. Killeen often adds one when the pocket needs support, and only when there is a good reason for it.
Scaffold use in the breast is off-label: these products are used in other soft-tissue repairs, such as hernia repair, and none is FDA-cleared or approved for use in the breast. Whether scaffolds lower the chance of contracture coming back is still being studied. For cosmetic patients, this part of the surgery is typically not covered by insurance. Learn more about dermal matrix and mesh.
Pocket Change and Muscle Repair
Contracture can pull the chest muscle up along with the capsule. When an implant sits under the muscle, Dr. Killeen may move it above the muscle as part of the repair, always together with removing the capsule, never instead of it. Whether the implant goes above or below the muscle is decided case by case.
When an implant is moved above the muscle or removed, she repairs the muscle back to the chest wall whenever possible. After a long-standing contracture under the muscle, the muscle can become scarred and may not fully return to normal, and she discusses that before surgery.
Approaches She Avoids for True Contracture
- Capsulotomy (slits) and a smaller implant: She uses capsulotomy only for position problems, not true contracture.
- A new pocket over the old capsule: She removes the entire capsule rather than working around it.
- A textured implant swap: She does not use textured implants because they are linked to BIA-ALCL, a rare lymphoma that can form around the implant, and swapping implants without removing the capsule does not address the problem.
Your Repair, Step by Step
- The old implant is removed. The breast crease is her preferred incision for complicated revisions.
- The entire capsule is removed.
- A sample is sent for PCR bacterial testing.
- The pocket is cleaned with pulse lavage.
- Gloves and instruments are changed, and the rest is done as a clean operation.
- Any pocket change or muscle repair is done.
- A brand-new implant is placed, with a scaffold when the pocket needs support, or the incision is closed if implants are coming out.
- After surgery, you take antibiotics that cover the bacteria Dr. Killeen finds most often. Once your test results return, they are tailored to your result.
Recurrent Capsular Contracture: Lowering the Chance It Comes Back
Recurrent capsular contracture can happen after any repair. Recent published studies cite recurrence rates of 7 to 25%, and in Dr. Killeen's view, how the contracture is treated matters most.
At a first augmentation, several steps lower contamination: an incision in the breast crease, a funnel so the implant goes in without being touched, covering the nipples during surgery, antibacterial irrigation of the pocket, and fresh gloves before handling the implant. No single step does it alone, and Dr. Killeen credits these operating room techniques with much of the drop in contracture over the past 10 to 15 years.
In Dr. Killeen's view, technique matters more than the implant. Newer brands often compare their contracture rates against much older data from established brands, so brand contracture claims deserve a closer look. Studies show somewhat lower rates under the muscle, but with modern technique she believes contracture risk alone should not decide whether your implant goes above or below the muscle.
Long term, an implant is a medical device that needs care. Treat infections anywhere in your body promptly, including mastitis, and keep up follow-up visits. For silicone implants, Dr. Killeen prefers ultrasound starting about 5 years after surgery and then every other year, in line with FDA guidance to image periodically. There is no strong evidence that antibiotics before a routine dental cleaning prevent contracture; talk with your surgeon and dentist about deep cleanings or an active infection.
Questions to ask any surgeon about your contracture repair
- Will you remove the entire capsule?
- How will you check for biofilm?
- Which antibiotics will I take, and for how long?
- Will you clean the pocket with pulse lavage and change gloves and instruments before the new implant goes in?
- Will I get a brand-new implant?
- Will you use a scaffold, and if so, why?
Capsular Contracture After Radiation or Breast Reconstruction
Radiation raises the risk of contracture and stiffens tissue. Dr. Killeen still routinely places implants in patients who will have radiation, and in her opinion it is better to place the implant before radiation than to operate afterward. Learn more about breast reconstruction with Dr. Killeen.
Stiffness or Contracture?
A radiated breast is always somewhat firmer, so the first step is telling normal radiation stiffness from a true contracture. Reconstruction implants are firmer than cosmetic implants by design, but they should still feel soft. A really hard reconstructed breast is likely a contracture.
Treating It Without a Flap
A contracture in a radiated breast can be treated without converting to a flap (rebuilding the breast with your own tissue), and it is often worth trying to save the implant reconstruction. Her approach removes the full capsule while protecting thin, radiated skin, and fat grafting, when needed, is sometimes staged for later. For other changes to a reconstruction, see breast reconstruction revision.
Before a Lumpectomy or Radiation
If you have implants and face a biopsy, lumpectomy or radiation, see a plastic surgeon first, so an aging or contracted implant can be handled in the same operation when possible. Contractures in radiated tissue are far harder to treat. Here is why implant care matters before breast surgery.
Insurance Coverage and Implant Warranties
If you were told contracture surgery is never covered for cosmetic implants, that is not accurate: coverage depends on your plan and your grade. The practice is out-of-network, and Dr. Killeen's billing team submits pre-authorizations and handles documentation, denials and appeals. Read more about insurance coverage for contracture surgery.
Cosmetic Implants
Some plans cover implant removal and capsulectomy for a severe contracture, typically Baker IV and sometimes Baker III. The new implant, scaffold, lift or fat grafting usually is not covered. Some plans exclude all complications of cosmetic implants, and in that case an appeal will not change the answer.
Reconstruction After Cancer or BRCA
Removal, capsulectomy and a replacement implant are typically covered, and a scaffold may be too. Under the federal Women's Health and Cancer Rights Act, most plans that cover mastectomy must also cover all stages of reconstruction and physical complications of the mastectomy.
Other Reconstructive Reasons
For implants placed for other reasons, such as tuberous breasts or after a benign mass was removed, coverage is inconsistent and depends on your plan.
Insurance and Warranty Tips
- Ask before, not after: Request a pre-authorization before surgery, even if you were told no in the past.
- A phone "yes" is not approval: It usually means only that the procedure code exists, not that you meet the criteria.
- Outside the classic criteria: Letters of support from several of your doctors can help.
- Implant warranties: A true contracture is usually covered by the implant maker's warranty unless the implant is very old. The company should pay at least for the new implant and may contribute toward surgery; terms vary, and implants placed abroad can be hard to claim. In warranty cases, Dr. Killeen uses the same brand so the warranty applies.
The Capsular Contracture Procedure
Consultation and Imaging
Dr. Killeen examines you, reviews your history and any prior operative notes, and talks through whether you want to keep implants. If you have silicone implants, you will have an ultrasound or other rupture screening before surgery, and she can perform one in the office. Her team can also start an insurance pre-authorization.Timing Your Surgery
For an early contracture, waiting a couple of months usually lets the tissue soften, which makes the operation easier and safer. If you are breastfeeding, surgery waits until about 6 months after you stop. A ruptured silicone implant is not an emergency but should be addressed within a couple of months. If you plan more children, Dr. Killeen generally recommends fixing a severe, painful contracture first, knowing pregnancy can change the result.Surgery Day
Surgery length varies with complexity, including whether a scaffold, lift or muscle repair is added. Surgery takes place in an accredited surgical facility, and your anesthesia plan and location are confirmed at your consultation.
Recovery Timeline: What to Expect
Recovery depends on what your repair includes. The milestones below are typical after implant removal with capsulectomy; a repair with a new implant, a scaffold or muscle repair may differ, and Dr. Killeen confirms your timeline at your consultation. Muscle repair adds some tenderness, but the recovery is manageable. Read more about recovery after implant removal.
First Week
Most patients feel pretty good during the first week. Your specific instructions are reviewed at your consultation.Weeks 1 to 4
Many patients return to desk work and driving at about 1 week. Avoid heavy exercise during this time.About 1 Month
Most patients return to full activity at about 1 month, once cleared by Dr. Killeen.3 to 6 Months and Beyond
The new capsule matures and the breast continues to soften over the following months.
Your Results
Results develop over months. Revisions soften more slowly than a first augmentation, because every operation in the same area adds some scar tissue that does not fully go away. Your follow-up visits track how the breast softens and settles.
Who Is a Good Candidate?
Good candidates for capsular contracture surgery include patients who:
- Have an implant breast that is firm, painful or distorted (Baker III or IV)
- Have a contracture along with a ruptured silicone implant
- Have recurrent capsular contracture after one or more earlier repairs
- Have a reconstructed breast that has become hard
- Are in good general health
- Are not pregnant or breastfeeding (surgery waits about 6 months after weaning)
- Are non-smokers or willing to stop smoking before surgery
- Have realistic expectations about softness, scarring and the chance of future surgery
Frequently Asked Questions
Schedule Your Beverly Hills or Los Angeles Capsular Contracture Consultation
Soft, Comfortable Breasts Start With the Right Diagnosis
If your implant has become firm, painful or distorted, you do not have to live with it.
The first step is an exam with a plastic surgeon to diagnose the actual problem, because contracture is treated differently from other implant issues. Dr. Killeen will walk you through your options, including keeping or removing implants, and what your insurance may cover.
Get a clear diagnosis and a plan built around your goals.
Schedule Your ConsultationSoft, Comfortable Breasts Start With the Right Diagnosis
If your implant has become firm, painful or distorted, you do not have to live with it.
The first step is an exam with a plastic surgeon to diagnose the actual problem, because contracture is treated differently from other implant issues. Dr. Killeen will walk you through your options, including keeping or removing implants, and what your insurance may cover.
Get a clear diagnosis and a plan built around your goals.
Schedule Your Consultation