I Have Capulature in Left Breast Which is Under Muscle, Right Implant is Above Muscle..How To Revise?

Have had left muscle form capulature status since implanted 6 years ago, now it is under armpit and so high and hard that it is obvious in shirts.. I had a mammogram this month that disclosed this implant is below muscle, my right is above...confronting surgeon, he has agreed to replace left breast/2year warranty as he puts it...In his office about hour procedure...it is 3:00 am..surgery is to be Thursday...safe/or do both implants need to be replaced so that they're even in shape and size-

Doctor Answers (9)

Breast Revision Surgery-Surgery center

+1

If both are not done and placed in the same surgical pocket they will look different. You could put the righton top of the muscle and this may work well.. I alway perfer them underneath the muscle.A ultra clean strerile enviroment is very important.


San Francisco Plastic Surgeon
4.5 out of 5 stars 30 reviews

Breast Revision

+1

I recommend you see a Board Certified Plastic Surgeon, and have the surgery done in an accredited surgery center.  The surgery needs to be ultra clean and avoid infection of the implant.  You need to be very careful.  Your surgeon may have a clean office, but an accredited surgery center is cleaner, and your risks will be lower.

Vivek Bansal, MD
Danville Plastic Surgeon
5.0 out of 5 stars 9 reviews

Breast implant position

+1

In general, it is best to have both implants in the same pocket position. Make sure you are consulting with a board-certified plastic surgeon with significant experience with revision breast surgery. Raise any questions or concerns with your surgeon prior to surgery and seek a 2nd opinion if you're not comfortable with the advice. Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 751 reviews

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Breast Implant Revision -I Have Capulature in Left Breast Which is Under Muscle, Right Implant is Above Muscle..How To Revise?

+1

Hi,

As is often the case, there are no absolute answers to this situation.

You can certainly argue that if the right is okay, you should leave it alone and just address the side that's a problem.  You can, for example, develop a problem on the right side even though you don't have one now, so I don't think it's a given that you have to do both.

The simplest approach is to address only the problem side - the left.  But addressing that may not be so simple.  In general, an implant under the muscle should be less likely to form a capsule than one that's above the muscle, though even that's not 100%.  But once you have a capsule, you first need to remove at least part of the scar tissue, insert an implant and, finally, consider adding a material such as acellular dermal matrix (ADM), like Alloderm or Strattice.  These have been shown, with relatively short followup (a few years), to help keep the breasts soft and to diminish the likelihood of the scar tissue re-forming.  That has always been the problem - even if you remove the scar tissue, what can you do to prevent it from forming again?  ADM may provide a solution.

In general, this procedure would take me much longer than an hour.  I would do it in my office, but my office contains a fully-accredited surgical facility (accredited by aaasf - you can check that organizations site at www dot aaaasf dot org).  I would consider adding ADM, though I don't know that it would be mandatory.

At any rate, I think this is a discussion you need to have with your surgeon and, in the meantime, you can do some more research on the material.  Another factor is that it's expensive, but that, too, needs to be judged in context.

I hope that this helps, and good luck,

Dr. E

Alan M. Engler, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 151 reviews

Replacement of implant for capsular contracture

+1

Replacement of the implant may not totally solve your problem.  You may need an acellular dermal matrix to decrease capsule recurrence and not just a change of pocket site.  Discuss this with surgeon.  Donald R. Nunn MD  Atlanta Plastic Surgeon.

Donald Nunn, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 5 reviews

Fixing implant surgery

+1

IT sounds like at the minimum you need the one that has a tight capsule fixed. If the other one is OK, you can just match them up.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 17 reviews

I Have Capulature in Left Breast Which is Under Muscle, Right Implant is Above Muscle..How To Revise?

+1

There are a couple of ways to deal with capsular contracture- remove the capsule entirely (capsulectomy) or score the capsule (capsulotomy).  In a severe capsular contracture, which it sounds like you have on the left, the best way to deal with it is to completely remove the capsule.  Because your opposite implant is above the muscle and seems to be giving you no problems, you may want to consider placement of the new implant above the muscle to match the right side.  The choice to replace only one implant has the advantage of only operating on one breast, but there may be issues with symmetry if you only replace the one side.  I also recommend that you consider getting a second opinion- then decide what is the best decision for you.

Amy T. Bandy, DO, FACS
Newport Beach Plastic Surgeon
5.0 out of 5 stars 86 reviews

Revising capsular contracture

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Capsular contracture is usually lessened by submuscular implant placement. The dilemma is that your left subglandular implant is well. If you like the left then it makes sense to place the right implant into a new subglandular pocket above the old. We would close off the submuscular pocket and leave it in place. A new implant is best, and new on both sides if symmetry is an issue. You might wish to have a second opinion if there are confidence issues with the first.

Best of luck,

peterejohnsonmd

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 29 reviews

Treatment of severe capsular cintracture

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Greetings, Your description of your implants sounds consistent with a very severe capsular contracture. Usual treatment for that is removal and replacement of implants, removal of the capsule, and possible placement of drains. I usually perform that in the OR and it takes well more than an hour to perform. Beat of luck.

Sam Jejurikar, MD
Dallas Plastic Surgeon
5.0 out of 5 stars 31 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.