Should I move from under to over to address CC? - Risks of more issues
Doctor Answers (7)
Options for capsular contracture in thin athletic patients
Moving Breast Implant From Under to Over to Address Capsular Contracture?
Historically, one of primary ways of dealing with capsular contracture was to change pocket location. In the past, this usually meant moving from the sub glandular (over) to the sub pectoral (under) position, because years ago augmentation was most frequently done over the muscle, and capsular contracture rates were quite high. Today we know that the capsular contracture rates for sub glandular implants is high, especially for smooth implants, so most surgeons avoid doing augmentation this way. In your situation, going from sub muscular (under), to sub glandular (over), means that your implant will be moved to the location where capsular contracture is highest. I, like you, would be very concerned with the risk of recurrent CC.
Some other considerations. Are both implants being relocated to over? If not, then your breasts will not likely look symmetric. Is your surgeon using a new implant? It is recognized that one of major causes of capsular contracture is contamination of the implant with a small number of bacteria when the implant was put in. The bacteria adhere to the implant shell and form a biofilm that protects them your bodies defenses. However, if your body can't kill off the bacteria, it creates a state of chronic inflammation which results in capsular contracture. So you should at least be getting a new implant as well.
It is true that a sub glandular implant (over) will have less of an issue on animation deformity (distortion with muscle flexion), but if your tissues are thin, then you are likely to face the problems of a visible implant or visible rippling - also highly undesirable.
Another approach to managing capsular contracture is the addition of Strattice to the corrective procedure. There is increasing data that indicates that adding Strattice can significantly reduce the rate of recurrent capsular contracture. Also, part of the treatment of your capsular contracture will likely include a capsulectomy which will further thin your already thin tissues. Strattice will provide extra support for the implant, thus minimizing the risk of subsequent malposition, and the Strattice will provide extra coverage of the implant, thus reducing the risk of implant visibility. Strattice has even one more benefit for you. When the Strattice is sutured in place, it is usually sutured to the inferior border of the pectoralis muscle and then is sutured to the chest wall. This creates a sort of hammock that supports the implant, but also serves to minimize the upward motion of your muscle thus minimizing your animation deformity.
So, my recommendation in your situation would likely be to revise both sides to maintain symmetry, capsulectomy of the effected side, new implant, keep the implant in the sub muscular (under) position, add Strattice for the benefits of minimizing risk of capsular contracture, better support of the implant in thin tissues, reduced risk of visible implant through thin tissues, and minimizing the animation issue from a sub muscular implant.
The Strattice solution is really the only one that addresses all of your potential problems and will most likely give you a satisfactory long term solution. It is, unfortunately, also an expensive solution because the material is costly and the surgery to position it is time consuming. However, is it not better to invest more in something that has a higher chance of working properly and minimizing other problems. Far too often I see patients who have undergone multiple revisionary procedures to treat capsular contracture, only to have it recur or develop other problems. They have spent more money on the multiple procedures than what it would have cost to do it once with Stattice. When you consider the risks of some the lesser approaches to treating capsular contracture, the Strattice option starts to look awfully attractive. It is not always the preferred solution, but should be in the mix of options. The old approach of simply changing pocket location is no longer the preferred solution.
Revision Breast Augmentation for Capsular Contracture
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Earl Stephenson, Jr, MD, DDS, FACS