Capsular contraction can be associated with ruptured implants, particularly when significant chronic inflammatory changes occur. However patients with intact implants, saline or gel, may develop capsular contractures. Capsules when tightened may become thickened or remain thin and still cause implant shape change. Capsular contraction can occur with saline or silicone implants, textured or smooth implants and with implants placed above or below the muscle.