Hard, distorted, and painful implants from capsular contracture demand more than a simple implant swap. Dr. Tachmes performs total capsulectomy — complete removal of the hardened capsule — for Baker Grade III and IV cases, eliminating the source of recurrence, not just the symptom.
Submit Your Case for Dr. Tachmes' ReviewOr call Dr. Tachmes directly: 786-603-9074 — no coordinators.
Every breast implant triggers the body's natural healing response — a thin layer of fibrous tissue, called the capsule, forms around the implant. For most patients, this remains soft and undetectable. For others, the capsule thickens, hardens, and begins to contract around the implant.
Capsular contracture is the most common reason for breast implant revision surgery. At lower grades, it causes firmness. At higher grades, it produces visible distortion, chronic pain, and a breast that is cold, hard, and unresponsive to touch. The result bears no resemblance to a natural breast.
Baker Grade III and IV contractures require surgery. There is no massage protocol, no medication, and no non-surgical treatment that reliably resolves severe contracture. The only effective treatment is complete removal of the contracted capsule followed by implant replacement — done correctly, by a surgeon who specializes in revision.
Dr. Tachmes has spent 32 years correcting complex capsular contracture cases in Miami Beach, including cases that other surgeons have attempted and failed to resolve.
Capsular contracture severity is classified on the Baker scale from I to IV. Only Grades I and II can be managed conservatively. Grades III and IV require surgical revision.
| Grade | What You Experience | Treatment |
|---|---|---|
| Grade I | Breast looks and feels completely natural | Monitor |
| Grade II | Slightly firm to touch; normal appearance | Conservative |
| Grade III | Visibly hard and distorted; discomfort present | Surgery |
| Grade IV | Hard, painful, cold, severely misshapen | Surgery |
The choice of surgical technique determines whether capsular contracture resolves or returns. Two approaches exist: capsulotomy (cutting or releasing the capsule) and capsulectomy (removing it entirely).
Capsulotomy is faster and involves less dissection, which is why many general plastic surgeons default to it. It also has a recurrence rate that many revision specialists consider unacceptably high — the capsule is still there, only loosened. Without removing the source of the contracture, re-hardening is common.
Dr. Tachmes performs total capsulectomy — complete excision of the entire capsule, leaving no contracture tissue behind. For certain cases, he performs en bloc capsulectomy, removing the capsule and implant together as a single intact unit without disrupting the capsule shell.
After capsule removal, the pocket is thoroughly irrigated with triple antibiotic solution to eliminate subclinical bacterial contamination — a leading driver of contracture formation that is often overlooked.
Under general anesthesia, Dr. Tachmes removes the entire contracted capsule using meticulous dissection. The surgical pocket is then irrigated with antibiotic solution.
A new implant is placed using a no-touch technique to minimize bacterial transfer. When the original placement was subglandular (above the muscle), Dr. Tachmes may convert to submuscular placement, which has a lower contracture recurrence rate.
Drains are typically placed and removed within the first 7–10 days. A soft compression garment is worn for 6 weeks.
Capsular contracture can recur after revision if the surgery doesn't address the root causes. Dr. Tachmes reduces recurrence risk through complete capsule removal, antibiotic irrigation, no-touch implant placement, and pocket conversion from subglandular to submuscular when indicated.
In patients with prior radiation or multiple recurrences, acellular dermal matrix (ADM) may be added to reinforce the pocket and further reduce recurrence risk.
Surgery duration: 2–3 hours
Anesthesia: General
Drains: 1–2 drains, removed at 7–10 days
Return to work: 1–2 weeks (desk work)
Compression garment: 6 weeks
No strenuous activity: 6–8 weeks
Final results visible: 3–6 months
Capsular contracture correction is one of the most technically demanding revision procedures. The quality of the capsule removal, the thoroughness of decontamination, and the technique of implant placement all affect whether the contracture resolves permanently or returns.
Dr. Tachmes' practice focuses exclusively on breast revision — not general plastic surgery with revision cases mixed in. That specialization translates to technique refinement and outcome consistency that generalists cannot replicate.
Recovery from total capsulectomy with implant replacement is more involved than a straightforward implant exchange. The more extensive dissection required to remove the capsule means additional healing time and activity restriction.
Most patients describe the first week as manageable with pain medication and activity limitation. Drains are removed at the first follow-up appointment. The majority of patients return to desk work within 10–14 days.
The compression garment worn for 6 weeks serves two purposes: reducing swelling and providing mechanical support to the pocket while it heals. Removing it prematurely — or returning to exercise too soon — increases recurrence risk.
Final results are not immediately visible. Swelling from capsule removal and pocket repair can take 3–6 months to fully resolve. The new implant will settle gradually, and the final shape and softness typically emerge between 4 and 6 months post-operatively.
Dr. Tachmes monitors each patient closely through the recovery period with multiple follow-up appointments to ensure the pocket heals correctly and recurrence is not developing.
Actual patients of Dr. Tachmes. Each case represents a total capsulectomy with implant replacement, tailored to that patient's grade, anatomy, and history.
Every consultation starts with Dr. Tachmes personally reviewing your photos and history — not a coordinator or PA. Submit your case and receive a direct response about your capsular contracture treatment options.
Submit Your Case for Dr. Tachmes' Review Call Now: 786-603-9074