Signs That Breast Implants Are Encapsulated?

I've had saline implants for a year now. I kept telling my doctor that it felt as if the left one had never even "set in" and that both feels unnatural. He brushed this off. I have an appointment next week...Now they are saying it is probably encapsulated. Does this sound right? They are both so hard I now turn my body to give a hug! The right side is somewhat softer, but nowhere near others I have talked to.

Doctor Answers 40

You have severe capsular contractures which need to be treated correctly

To benhazed,

Hi! I am afraid you need a revision, and how it is done is crucial.

1) You need CAPSULECTOMIES. That means the existing lining around your implants needs to be removed. This lining has myofibroblast cells which cause capsular contracture.

2) You need NEW IMPLANTS. Your current implants have a biofilm on their surface which may contain bacteria, and even a few bacteria will cause capsular contracture. You don't need to have an obvious infection to develop another capsular contracture. This biofilm cannot be washed off.

3) The wounds should be irrigated with antibiotic solution, for the same reason.

4) Every last little bit of bleeding around the implants needs to be completely stopped, because even a small amount of blood can cause capsular contracture. I often use drains for a day or two in this situation.

Manhattan Plastic Surgeon
4.8 out of 5 stars 9 reviews

Capsular Contracture - How to prevent it

Capsular contracture can occur on one or both sides, and while it can develop early (weeks) or late (years) after a breast augmentation surgery, in the vast majority of cases it is evident fairly early following the procedure. So the good news is that once you are six to 12 months out from your surgery, if your augmented breasts are soft and supple then they are likely to stay that way for the long term.
It is believed that capsular contracture is primarily a response to the presence of low-virulence or non-virulent bacteria (i.e. not the kind that generally produce an actual infection, with redness/tenderness/fever etc) that adhere to the implant surface on the day of surgery, and which over weeks and months following surgery stimulate the cells that make collagen (called fibroblasts) to make more collagen - thickening the capsule and stimulating it to contract and tighten around the implant. It is not an actual infection; there are no symptoms that this is going on, and taking antibiotics will not prevent the process or reverse it. The source of these non-virulent bacteria is thought to be the patient's skin, or the ductal systems of the breast that lead to the nipple, as both are normally colonized with bacteria.
Because plastic surgeons now have an understanding of some of the reasons why capsular contracture occurs, there are a number of measures that can be taken to significantly reduce the likelihood that it will happen following breast augmentation surgery
Because of a number of techniques I use during breast augmentation surgery that are outlined below, I see very few capsular contractures in my breast augmentation patients. However, the reality is that if you are a breast augmentation patient with a capsular contracture, the incidence - at least to you - feels like 100%. A well-established capsular contracture can be corrected, but doing so involves a return to the operating room, removing and discarding the implant, removing or excluding the contracted capsule, creating a completely new implant space, and putting in a new breast implant (that statement may be somewhat controversial, but I believe the procedure just described is what is what provides a patient with the lowest risk of recurrent contracture). So I think that surgeons should feel obliged to do everything possible to limit the likelihood that a patient develops this frustrating postoperative problem.
Studies have shown that a bacterium called Staph epidermidis can be cultured from as many as 70% of capsule specimens obtained during surgical procedures for capsular contracture. So I employ a number of measure that address the possibility that skin bacteria or nipple duct bacteria may adhere to the implant surface during the augmentation procedure. We prep the skin using potent antiseptic solutions prior to draping the surgical site with sterile drapes, however the microscopic surface of the skin is full of peaks and valleys, and `nooks and crannies' - like sweat glands, hair follicles and sebaceous glands - that may harbor bacteria despite thorough application of an antiseptic prep solutions.
After prepping, we apply a new skin sealant product called InteguSeal to the skin surface where the incision is to be made. This effectively seals off all of the `nooks and crannies' that may harbor bacteria, and the sealant lasts for several days postop. We also apply it over the nipple and areola to seal off the nipple ducts which may also harbor bacteria.
Over the course of the surgery, we irrigate the implant space several times with a large volume of a saline solution containing three antibiotics (which can be modified in patients with an allergy to any of the antibiotics in the solution). Prior to implant placement, we irrigate the implant space with full-strength Betadine, a potent topical antiseptic that has been shown in clinical studies to reduce the incidence of capsular contracture.
I think one of the greatest advances in reducing the possibility of implant contamination by skin bacteria during breast augmentation surgery is the development of a soft, sterile, paper funnel for insertion of silicone gel implants into the implant pocket. This simple yet clever device actually looks much like a pastry chef's bag. It allows me to introduce the implant into the subpectoral pocket without ever touching it with my gloves, and without the implant ever contacting the patient's skin surface. The implant package is opened, the implant is irrigated with antibiotic solution then `poured' into the funnel, the small end of the funnel is inserted in to the skin excision which is held open with retractors, and I gently `squirt' the implant into the pocket. Before this was available, there was a great deal of implant contact with the patient's skin, under great pressure, as a pre-filled gel implant is forced into the pocket through a relatively small incision. The implant insertion funnel completely eliminates what I think has been the most concerning aspect of breast augmentation surgery in regards to the potential contamination of the implant with bacteria during the procedure.
There is no breast augmentation practice with a capsular contracture rate of zero. Yet there are obviously a number of measures that can be taken to make the rate of contracture as low as possible. I think it is important for patients to have confidence that their surgeon is focused not only on providing a breast enhancement that is beautiful and natural-appearing, but also on maximizing the likelihood that their aesthetically pleasing result will remain beautiful and natural-appearing over the long term.

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 118 reviews

You may have a capsule forming or may want to consider silicone implants

You need to discuss your concerns with your doctor. Without examining you it is difficult to know exactly what is going on. Encapsulation can cause firm or even hard breasts. It is also possible that you are feeling the saline implants especially if you have very litlle breast tissue covering the implants. If that is the case, you might want to consider changing to silicone implants which can for some patients make the breasts feel softer even though they have little breast tissue to camoflage the implants .

Susan E. Downey, MD
Los Angeles Plastic Surgeon
3.9 out of 5 stars 9 reviews

What you’re describing sounds like capsular contracture

There are four grades of capsular contracture. What you’re describing—a feeling of hardness in both breasts, combined with discomfort enough that you need to turn aside to avoid the pressure of a hug—sounds like Grade IV capsular contracture, which is the most severe. This issue can only be resolved through breast revision surgery, which involves releasing or removing the scar tissue capsules and replacing your breast implants. You can return to your previous surgeon for this procedure, but I recommend seeking out a breast implant revision specialist for the best possible results.

Nirav Savalia, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 42 reviews

Capsular contracture

 If the breasts are firm and the implants are not mobile, then you probably have a capsular contracture.  This is something that you should definitely talk with your doctor about.  Most of the time you have to have the capsule removed to improve this situation.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 26 reviews

You may have a capsular contracture

Either you have a capsular contracture or your implants were too overfilled at the time of their insertion. These are basically the only ways a saline implant can feel too hard. Maybe your expectations of what is normal for a saline implant are also incorrect.

I would suggest you visit another surgeon with your operative note and ask their opinion as to what is going on here. If you have a capsular contracture, a revision could be very helpful. If the implants are too overfilled, a revision may also be advisable. Probably you should consider gel implants this time because they are definately the preferred impants when patients place a high priority on the "feel" of their outcome.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
4.8 out of 5 stars 67 reviews

A capsular contracture is the most likely problem

One of the potential complications of breast augmentation surgery is development of a capsular contracture. This is when scar tissue, which forms around the implant, becomes hard and potentially painful. Unfortunately, there is no easy way to address this problem other than surgery. The surgery would involve either making incisions through the scar tissue at several locations to allow the capsule to expand or removing the capsule completely. However, there is no guarantee you will not develop a new capsule in the future.

Discuss these options with your surgeon before making a final decision on whether to have a surgical revision.

David A. Robinson, MD
Munster Plastic Surgeon
4.7 out of 5 stars 42 reviews

Likely capsule formation.

Benhazed, The most likely explanation is that you have capsular contraction around your breast implants. This is a rare reaction by the body to the presence of a foreign material (the implant). Basically, the body forms a hard scar around the implant. You will likely need another operation to remove the capsule. If you implants were placed above the muscle the first time, it may be best to put the new implants under the muscle. Good luck.

David Shafer, MD
New York Plastic Surgeon
4.9 out of 5 stars 74 reviews


It sounds like you do have encapsulation. During your next post operative consultation convey your concerns to your  surgeon and explore all the possibl alternatives.

Barry H. Dolich, MD (Retired)
Bronx Plastic Surgeon
4.0 out of 5 stars 1 review

Symptoms of Capsular Contracture

If you are experiencing any of the following symptoms, you should be evaluated by your plastic surgeon; if the diagnosis is made of capsular contracture, depending on its severity, the implants may need to be removed and replaced.


  1. The implant begins to feel hard
  2. The implant looks smaller, more ball-shaped, or distorted in some other form
  3. The implant is higher on your chest
  4. Pain, tightness, discomfort in your chest

    I hope that answers your question on capsular contracture. It’s great that you’re doing this research. I always say that the best patients are informed patients.

    You might also want to research your options for breast implants. Choosing the right implant is the number one concern among women considering breast augmentation. Did you know, there’s actually a way to select a implant shape, size, and profile that is perfect for you?

    A term that I use with my patients for the perfect implant is the “Pony Implant”.

    So what do I mean by “perfect”? Well, a Pony Implant has three qualities to it. First, the implant meets your beauty goals. For example, you want to your breasts to look fuller while still appearing natural.

    Second, when you chose your Pony Implant, you walk out of your consultation 100% confident that you’ve chosen the right shape and size for you. In other words, you won’t be second guessing your decision, and you won’t be afraid of having gone too big or too small.

    And third, after your procedure, you are thrilled with your results, and say, "I’m so happy. This is exactly what I wanted!"

    That’s the Pony Implant. And the great news is that there is a simple process to go about finding yours.

    This issue of selecting the right implant is so important when it comes to patient satisfaction or dissatisfaction that, again, I really encourage you to learn more about it.

    Thank you for reading and best of luck on your journey!

William Rahal, MD
Beverly Hills Physician
5.0 out of 5 stars 31 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.