Breast revision surgery after unsuccessful closed capsulectomy. What are the chances of CC returning?

Against better advice from this site, I went forward with a Closed Capsulectomy. Needless to say, it was unsuccessful & I needed to have open capsulectomy surgery. Turns out my implant was ruptured. My implants were moved from over muscle to under. What the chances of cc returning? I was not placed any prevenative meds after surgery. However, I was instructed to massage twice a day. Am I at higher risk of cc reoccurring?

Doctor Answers (8)

#BreastImplantRevision - What are the chances of CC returning?

+2
Nobody can say for sure but, in general, capsules appear to be more common when they are recurrent (ie, when you've already had one) than for those that are not.  But I can't quote exact statistics and, of course, from your standpoint it doesn't matter how many people out of a hundred have had it - the only thing that matters is if you get it again.

Putting the implant under the muscle makes sense, as does switching to textured implants (in general...and there are advantages and disadvantages to every decision).  Most surgeons wash/soak the implants in an antibiotic solution.

Beyond that it's not clear what else can be done (the medicine Singulair has been used, with some success, but there are downsides to that, too).

I hope that this helps and good luck,

Dr. Alan Engler
Member of RealSelf100


New York Plastic Surgeon
5.0 out of 5 stars 155 reviews

Breast Implant Removal

+2
Hi,
Sorry you are having all this trouble.  Yes you would be at a slightly higher risk.  The past is the best predictor of the future.  Still, it should be only about 3% or a little more with a new pocket under the muscle.  Ask you PS about using the medication, off label, called Singulair.  All the best, Dr. Joe

Joe Gryskiewicz, MD, FACS
Minneapolis Plastic Surgeon
5.0 out of 5 stars 65 reviews

Am I At A Higher Risk For Capsular Contracture If I Have Had A Previous Capsular Contracture?

+2
The answer to your question depends on what caused the capsular contracture. 

1.  One's immune system - If you have an immune system that overly protects you against any foreign invader, i.e. an artificial hip, pacemaker, breast implant, etc., then it is very likely that you will get a second capsular contracture.  Fortunately, this type of immune response is very, very rare.

2.  Blood around a breast implant - Blood around a breast implant increases the chance of a capsular contracture significantly, and a hematoma (large collection of blood) almost certainly means a second capsular contracture.  

3.  Non-pathogenic bacteria (one's own skin bacteria) - This increases the likelihood of a second capsular contracture, whether leftover from the previous capsulectomy or being introduced in the redo surgery.  

4.  All the above - Obviously, a combination of any of the above three will certainly lead to a second capsular contracture.

5.  Unknown - Obviously, the science of capsular contracture hasn't been completely worked out yet.  All foreign bodies in the human body are surrounded by a scar known as a capsule.  The mechanism that changes a capsule into a contracted capsule is not fully understood at this time.

A general answer to your question of "are you at a greater risk for a second capsular contracture" is possibly yes depending on which of the above causative factors were involved in your first capsular contracture. 

S. Larry Schlesinger, MD, FACS
Honolulu Plastic Surgeon
5.0 out of 5 stars 232 reviews

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Breast revision for capsular contraction and ruptured implant

+2
It is impossible to give you an accurate answer.  However the chance of capsular contraction should be less with a breast implant placed beneath the chest muscle.  Breast implant displacement exercises may help as well.

Brooke R. Seckel, MD, FACS
Boston Plastic Surgeon
5.0 out of 5 stars 37 reviews

Capsular contracture

+2
sorry for the problems that you have had but the good news is that the incidence of capsular contracture is significantly lower behind the muscle then in front.

Dr. Corbin

Frederic H. Corbin, MD
Brea Plastic Surgeon
5.0 out of 5 stars 34 reviews

Capsular contracture

+1
You are definitely at higher risk of recurrent capsular contracture.  Sometimes removal of the contracted capsule can solve this problem.  It is unlikely any of us can give you an idea of your chances that the breast will remain soft.

I would suggest that you try Accolate or Singulair.  Patients usually can't notice any difference after they start the medication and the risks are minimal.  There is no guarantee that this will prevent firmness, but many of us believe that it helps.

If you do have a recurrence, the other surgical maneuvers that could help are the use of textured silicone implants, possibly the cohesive gel implants such as Allergan's 410.  I would also try the placement of an acellular dermal matrix such as Strattice.
 

Shim Ching, MD
Honolulu Plastic Surgeon
5.0 out of 5 stars 14 reviews

Capsular contracture

+1
Hi Diva07,

I'm sorry to hear that you developed capsular contracture and that you eventually required open capsulectomy and replacement of implants.

I agree with the previous answers.  Overall you are probably at an increased chance of developing a capsular contracture compared to a woman receiving implants for the first time.  Its very difficult to quantify the level of risk however.  If your new implants have a textured surface then they probably have a slightly lower chance of causing contracture.  Also, the neo-pocket and sub-muscular placement are known to reduce the risk of contracture. 

The surgery you have undergone has probably given you the best chance of avoiding a recurrence of the problem.

Joe's suggestion of Singulair is worth investigating. It wont hurt and there is (weak) evidence that it could help.  I hope this helps.

JC.


John Curran, MCh FRCSI (Plast)
New York Plastic Surgeon
5.0 out of 5 stars 3 reviews

No guarantees with revisional surgery for capsular contracture.

+1
I think a close capsulotomy is worth a try if the next step is surgery. Proper treatment is open capsulectomy and changing of the implant venue from above or below the muscle depending on its previous site. Whether or not previous capsular contracture predisposes you to capsular contracture at the time a revision is an unsettled issue.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 10 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.