H-5'3 W-125. Very active & healthy. December 2009 Breast augmentation to a full B size with Smooth Cohesive gel implants (gummy). Under the muscle. Dec. 2010 I received an open Capsulotomy because one breast never settled. 8 months later it started to harden and raise again. This July I'm looking to revisit for Capsulectomy (fly back to Miami) & doctor mentioned textured implant or to do procedure & use the same implant. I want to feel NORMAL & no discomfort, any advice is greatly appreciated.
Capsulectomy After a Capsulotomy. Advice For Revision?
Doctor Answers 6
Encapsulation Treatment Options?
Thank you for the question.
Unfortunately, the process of encapsulation is poorly understood and it's returns cannot be necessarily prevented. Using fresh breast implants, post operative “massage”, the use of anti-inflammatory medication/antibiotics may or may not help prevent recurrence of the encapsulation.
Ultimately, you will have to weigh the benefits of having breast implants versus the risk of recurrent problems. Unfortunately, the best “guaranteed” to feel “normal and no discomfort” would be to have the breast implants removed.
If you choose to keep breast implants in place, choose your plastic surgeon carefully and ask him/her to do everything possible to prevent recurrence.
There are several choices. If you believe the theories of capsular contracutre formation and biofims, then the implant and capsule should be removed and new implant placed. Some would even suggest removing the impalnt and capsule and waiting a few months to replace it. In recurrent capsule issues, some would add stratttice. Good luck. I am not a fan of textured implants.
Recurrent Capsular Contracture Treatment
Capsular contracture is a difficult problem to manage especially if it is recurrent. Treatment without surgery may be effective if therapy is initiated early. This includes the medication Singular 10mg at night, Omega 3 Fatty Acids (fish oil) I recommend Carlson brand 2,000 mg a day, and Vitamin E 1,000 IU a day. This can be coupled with breast massage and external ultrasound treatments. If non-operative treatment isn't successful, then I recommend complete capsulectomy with implant exchange for a textured implant or capsulectomy with creation of a neo-subpectoral pocket with use of a textured implant and ADM (Strattice) both with postoperative closed suction drains. Using a no-touch technique and antibiotic irrigation during implant placement is also important during the procedure. You should discuss these options with your surgeon.
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Sorry to learn of your difficult situation. You need to decide if the risks are worth another surgery or two. Capsular contraction is not fully understood. Here are three common solutions. One is to open and release the scar tissue and replace the implant. There is something called bio film which is why the implant should be replaced in my opinion. I would also use triple antibiotic irrigation during surgery and place you on a specific medication after surgery which may help lesson the return of capsule formation. Two is You could remove implants a 100% fix but you may not like the cosmetic outcome. Three is a very conservative option and is to remove implants for 6 months and then replace in a new plane which your board certified plastic surgeon can discuss with you. Good luck.
The problem is that we don't completely understand what causes the implant to "rise up" and the capsule to tighten. Some think that long term antibiotic suppression may help.
"Normal" breast augmentation
The harsh truth is that to be guaranteed of feeling "normal" you need to remove the implant. Implants and breast augmentations are imperfect. There are risks and side effects. You can reduce the risks and optimize the positive qualities, but once you put in a man-made implant, you are not "natural" or "normal". Patients who have a problem that is large enough to address surgically (i,e, capsular contracture, rippling, size mismatch, displacement) run the risk of incurring another, perhaps different problem. They end up what I call "chasing the imperfections." At some point, if you keep the implant, you have to decide on what imperfection you may be willing to live with. There are no easy answers, and any surgeon you tells you that is not telling the whole story. Textured implants while perhaps reducing the risk of capsular contracture for the first three years after implantation, end up with the same risk of capsular contracture further out and run the risk of increased rippling problems.
Robin T.W. Yuan, M.D.
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