This is the most effective solution for severe (grade 4) capsular contracture. It completely removes contracted, thickened capsules with implants, restoring a pocket back to its soft and spacious state of first surgery, and then places new implants. The surgery can be performed with a transaxillary, a periareolar, or an inframammary incision. First, endoscopy and ESUs are used to completely separate capsules from normal breast tissue. The whole capsule is removed with original implants, and ESUs are used to remove the remaining fibrotic scar tissue and dissect a new pocket space. Finally, new implants are placed to complete the surgery. This surgery is advantageous in that recurring or refractory capsular tissue can be completely avoided and that skin elasticity is restored. Without the influence of the remaining capsule or scar, the success rate of this method increases. However, this surgery is long and complex with more intraoperative and postoperative bleeding and a longer recovery period, adding more uncertainty to postoperative care. Patients’ skin may become loose and thin due to capsulectomy. Thus, for patients with less than ideal conditions or for those with repeated operations, problems such as breast ptosis or implant marginal puckering may be observed, which frequently entails replacement with larger implants to support breast tissues.