What Are my Options for Correcting Capsular Contracture for the Third Time?

I have Saline breast implants submuscular. I have a capsular contracture on my right side for the second time. I have taken all the necessary steps in preventing CC both times (massaging, vitamin e, singular) my initial surgery was September 1st 2010. Then the corrective surgery June 16th 2011, I know it will need to be removed and corrected yet again. Any advice on what I can to do prevent another capsular contracture? Perhaps I should go bigger or different implants???

Doctor Answers 14

What are my options for correcting capsular contracture for the third time?

There are several different treatment options for an established capsular contracture.. Many surgeons feel that it is important to create a site change and replace the implant with a new one. A site change refers to moving the implant to a new pocket location. For instance if the implant had been placed underneath the breast tissue the new pocket is made under the muscle layer. If the implant was originally under the muscle it can either be placed under the breast or in what's called a" neo-pectoral pocket". A neo-pectoral pocket is developed by temporarily removing the implant and creating a new pocket behind the back wall of the capsule surrounding the implant. The implant is then placed in this new pocket. Most surgeons agree that it is also important to put in a new implant when treating a capsular contracture. This is due to the possibility that the old implant is covered by "biofilm". Biofilm is thought to be one of the causative agents for a capsular contracture. Biofilm is a barrier that forms around some implants possibly secondary to a subclinical infection. A subclinical infection is one that affects the breast implant pocket but does not cause any other external symptoms.
One of the simplest ways to release a capsular contracture is by performing a capsulotomy. In the performance of a capsulotomy the previous incision is opened, the implant is removed and the capsule is then cut in several different locations to release the constrictions allowing the pocket to open up and return to its original size. The original implant is replaced with a new one and the wound is closed. In the past, however this procedure has been associated with a relatively high rate of recurrence. Two years ago I received some advice from a well respected plastic surgeon from Grand Rapids Michigan. He told me that he has been treating capsular contractures by performing the capsulotomy and then immediately placing the patient on a ten to fifteen day regimen of prednisone and a six-week regimen of Singulair. Both medications are started on the day of surgery. Over the last two years I have treated several capsular contractures with this regimen. None of the patients have had a recurrence of the capsular contracture and all of the patient's tolerated the medication very well.
Considering that you have developed a capsular contracture after two previous operations I think it would be reasonable to place you on the above-mentioned prednisone/Singulair regimen after your revisional surgery. Good luck

Omaha Plastic Surgeon
5.0 out of 5 stars 90 reviews

What are my options for correcting capsular contracture for a third time?

Hello! Thank you for your question!  Recurrent capsular contracture is a very difficult problem. Assuming you tried conservative measures in the past - implant massage and may add the medication Singulair and Vitamin E.  If these fail, surgical correction may be necessary. It is a matter of surgeon preference as well as what is seen during your procedure that will determine whether or not a complete capsulectomy is performed. If significant capsule formation is seen intraoperatively, a full capule removal may be warranted with a drain in order to completely remove all of the tissue and allow better adherence of your breast back to its normal anatomic position down on your chest wall. Irrigating with certain medications may also be if benefit. Some other things that may have been tried include changing the position of your implant, addition of a dermal matrix, or consideration for the the shaped, textured, anatomical gel implants.  

Without knowing your issues and without an examination, it is difficult to tell you what may be the best thing for you. I tend to favor performing capsulectomies in order to create a fresh pocket, reshape the pocket, allow better shape and adherence of the overlying breast. I would discuss your issues with your plastic surgeon who will assist you in determining the right modality for you.  At a 3rd recurrence, it may continue to occur despite all of these modalities and consideration for explantation or living with the contracture are options. Hope that this helps! Best wishes!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 14 reviews

What Are my Options for Correcting Capsular Contracture for the Third Time?

Sorry to hear about the complications you have experienced. Capsular contraction can be a very frustrating complication for both patients and surgeons.  In my practice, I have found the most success treating these difficult problems utilizing techniques such as sub muscular pocket conversion (if relevant), capsulectomy, use of fresh implants, and the use of acellular dermal matrix.  Acellular dermal matrix is a biologic implant that carries the ability to become integrated into native tissue. It is made by taking a full thickness section of skin from a donor source ( human, porcine, or bovine in origin).  I hope this, and the attached link (demonstrating a case utilizing acellular dermal matrix) helps. 

Breast Revision

You need to consult with a Board Certified Plastic Surgeon and evaluate the options.  Vitamin E is likely doing nothing for you, and the option of going bigger will increase your risks.  After being evaluated by a Board Certified Plastic Surgeon, they will give you all your options, even the option of doing an explant only and waiting for a time period before considering another implant.

Vivek Bansal, MD
Danville Plastic Surgeon
5.0 out of 5 stars 13 reviews

What are my options for correcting Capsular Contracture for the third time?

I have found tremenous success using Strattice alone with partial capsulectomies in my patients. Strattice is a xenograft made from the skin of pigs. It is essentially medical grade very thick dermis from skin. You are already under the muscle so the contracture typically comes from contact between the implant and your breast tissue.  I typically remove the capsule below the muscle and suture the Strattice to the crease and muscle thus providing for full implant coverage.  This will likely give you the best chance of keeping your implants and having a satisfactory result. Good Luck!

Steps to preventing a recurrent capsular contracture.

Recurrent capsular contracture is a difficult problem to correct. Options include total capsulectomy (removal of the entire capsule), site change of the implants, and the use of a dermal matrix such as Strattice. Dermal matrices have been shown to decrease capsular contracture rates significantly. The dermal matrix is typically placed along the lower pole of the implant, much like an internal bra. While your body will develop a capsule in every area which comes in contact with the implant, it will not create a capsule where the dermal matrix is located. In theory, it is the lack of continuous capsule around the implant which prevents the recurrence of a contracture. However, the drawback is the cost - dermal matrices can cost several thousand dollars. Of course, prevention of another surgery for capsular contracture will save you much more money in the long run! Other advantages include less visible rippling (due to increased tissue thickness), and better support of the implant over time.

David Bogue, MD
Boca Raton Plastic Surgeon
5.0 out of 5 stars 13 reviews

Breast Implant Revision - What Are my Options for Correcting Capsular Contracture for the Third Time?


The question is whether you want to (1) remove them and forget the whole thing, (2) try one of the options that have been suggested so far or (3) give it one more try and go all-out.

I would probably suggest option #1 or option #3.  What doesn't sense is to try one, relatively small change (ie, such as switching to textured implants).  That's okay for a second procedure but since you're already had a second procedure and developed a capsule almost immediately, I think you need a more substantial procedure.

So, if you're going to keep your implants (option #1 remains removing them altogether - though that has its own problems, including loss of volume and what to do with any excess skin) I would probably advise that you undergo a capsulectomy (total or partial), insertion of an acellular dermal matrix (such as Alloderm or Strattice - the early results with these materials are generally impressive) AND possibly a textured implant.  It simply doesn't make any sense to go through a third operation just to make a relatively small change.

I hope that this helps, and good luck,

Dr. E

Recurrent capsular contracture treatment

In cases as you have described, I have been impressed that capsulectomy and Strattice have to date always resolved the contracture issues in my practice. The other option is just remove the implants altogether. I am not convinced that texturing or the filling material makes much of a difference( gel vs saline). Sorry for your frustrating experience. Good luck

Craig Harrison, MD, PA
Tyler Plastic Surgeon
5.0 out of 5 stars 14 reviews

Recurrent capsular contracture

Saline implants tend to be firm, which can predispose to tight capsules.  Complete capsule release, exchange to silicone gel implants, and the placement of a membrane "patch" may help.  Biologic membranes that your body ultimately replaces with your own tissue have been shown to prevent capsular tightening.

What Are my Options for Correcting Capsular Contracture for the Third Time?

Maybe you are a scar former in your genetic history? You could try textured implants, though the ripples are bothersome. Change the location of the implants from submuscular to sub glandular. Or try Enriched PRP fat grafts to the breasts, size is a limitation though. 

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.