What Can I Do to Avoid Recurrence of my Baker II Capsular Contracture Following Capsulotomy (Scoring Capsule) & Pocket Revision?

I am scheduled to have revision surgery in two weeks. I have baker II contracture. I had 350 silicone implants placed through armpit in October 2010. They look good in clothes & ok but not natural in swimsuit due to stiffness. My breasts are fairly tight/hard to the touch and are sitting a bit high. PS plans to open the lower part of the pockets back up & perform capsulotomy. What is recommended for best results of such a procedure? Also, how should recovery be compared to initial surgery?

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12 Doctor Answers | Asked by winnnico in charlotte, NC

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What can I do to avoid recurrence of capsular contracture?

It is generally accepted that the risk of recurrence after simple capsulotomy (splitting the capsule but not removing it) and using the same implant is quite high. Most cases of capsular contracture are caused by bacteria in a biofilm on the implant that cannot be removed by antibiotics or washing the implant. Most plastic surgeons would suggest a complete capsulectomy and implant replacement so that the new implant resides in a fresh pocket. Other technical factors would... more

Preventing capsule contractures around breast implants

There is more information about bacterial colonies forming biofilms around implants causing capsule thickening and contractures around implants. So, in addition to the traditional capsulotomies and antibiotics, your surgeon should consider using an acellular dermal matrix to buildout the lower pole of the new implant pocket. There are current clinical trials looking at the use of cold lasers to prevent and treat capsule thickening, and finally the use of Accolate (Zafirlukast) a... more

Treatment of Breast Capsular Contracture

As you can see, this is a "grey area" and many different answers to your question have been posted. Reviewing the recent literature on capsular contracture, the consensus points towards removing (capsulectomy) versus scoring (capsulotomy) of the capsule. This may be due to the bio-film theory described in other answers. Perhaps removal of the capsule allow removal of the biofilm as well. Your surgeon may also consider placing the implant in another location... more

Capsular contracture, axillary incisiion, breast augment

It would be helpful to see pre and postop photos, but based opn your description, this problem may be somewhat different than a pure capsular contracture. I see this fairly often when a patient with a slight breast droop has an axillary placement of the implants and it is usually quite easy to correct using another incision than the axillary one. If the problem is what I think it might be, it has more to do with the lower edge of the muscle needing to be released from the... more

Contracture after augmentation

This is a difficult problem in the best of circumstances. Recurrence rates for correction of capsular contracture range from 35 to 50% of cases .

Best results after capsulotomy

There is some evidence that asthma medications can minimize and even reduce capsular contracture. I have had very good results in my patients with these inhibitors. Ask your surgeon about Accolate or Singulair. These drugs are safe and have few side effects. I usually prescribe a one month supply and evaluate the results. If there is a favorable response then I have my patients continue for a total of 3 months.

How to Avoid Recurrence of my Baker II Capsular Contracture Following Capsulotomy (Scoring Capsule) & Pocket Revision?

The best way to avoid caosular contracture is not to have a breast augmentation since contracture is seen in as many as 15% of women having a breast augmentation. Once you develop a contracture, the odds of it happening again are much higher despite the surgical treatment. Attempts at breaking up the scar tissue from the outside (Closed capsaulotomy) from the inside (Open capsulotomy), generally do NOT work long term. The best promise appears to be with subtotal removal of the acr with... more

Capsular contractures

Each case has to be individualized. If possible, it is best to remove the entire capsule, although is many cases this can be quite difficult especially in very thin patients if it is subglandular and also in subpectoral pockets when attempts are made to remove the posterior wall over the rib cage.

Steven Wallach, MD

12 reviews

Manhattan Plastic Surgeon

Treatment Of Capsular Contracture

Capsular contracture is difficult to correct and has a high recurrence rate. It is generally felt to be beneficial to change the pocket to a "virginal area" to improve the chance of not sustaining a recurrent contracture. Even with this manuever, the chance for a recurrence is moderately high.

Capsulotomy vs capsulectomy for capsule contracture

Hello, Capsule contracture is still debated among plastic surgeons but certain aspects are fairly well agree upon. A grade II or II capsule contracture is likely best handles by: 1) Full capsulectomy (complete removal of all of the capsule). This should be done in a bloodless field under direct visualization. 2) New implant 3) +/- drain Knowing that recurrence is high, I favor the "kitchen sink" philosophy where everything that is helpful is done to... more

How do I avoid recurrent contracture

My opinion, and it is opinion only, is that capsulotomy is unlikely to resolve your contracture over the long term. Evidence is strengthening that contracture is a result of chronic bacterial-host interaction between ductal microflora and the human immune system. The chief culprit is unknown, but staph epidermidis, propionibacterium acnes, staph hominis, Actinomyces spp., and other microbes have been cultured from within breast tissue, and may be involved. Capsulotomy does... more