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Previous Capsular Contracture from Under the Muscle. Should I Go over the Muscle or Do Fat Grafting?

asked 1 year ago by summer13 in Birmingham
Latest answer by Tim Abou-Sayed, MD
Question viewed 447 times
Tags: under muscle, capsular contracture, fat graft, over muscle

I had a previous contracture in both breasts about 10 years ago. Implants were placed under the muscle. They were removed a year later and did not replace them. I've seen 2 surgeons. One recommended fat grafting the other recommended placing a silicone implant over the muscle. Worried that the grafting will give uneven results. Also concerned about the higher possibility of contracture in over the muscle placement. Both doctors felt these possibilites were the best answer. Thanks!

8 answers to Previous Capsular Contracture from Under the Muscle. Should I Go over the Muscle or Do Fat Grafting?

+1

Revision breast surgery

I think your breast gland tissue has descended below the ideal position, more notably on the left than on the right. This gives the illusion that your nipples are too high, which they are in comparison to your fold under the breast, even if they are not too high with respect to your collarbones. I think you would be well served by revising the lift component of your result by tightening the skin, reducing the excess on the lower pole of the breast, and, if necessary, lifting your nipple... more
Tim Abou-Sayed, MD

Palm Beach Plastic Surgeon
+1

Fix the stretch deformity first

Your photo appears to demonstrate a "stretch deformity", i.e. increased distance between nipple and inframammary fold, especially on the left side.  In addition, the axis of your nipples are laterally (outwardly)displaced.  Like the other consultants, I think you would benefit from a breast lift (either primary or revisional) to tighten the skin brassiere first but also potentially improving both the lie of the nipples as well as the positioning of your native breast... more
Lavinia Chong, MD

Orange County Plastic Surgeon
+1

Breast issues

I am not sure of your question. Fat grafting can help to increase volume or camouflage some irregularities.  If you want to revise the lift, that can be done as well.
Steven Wallach, MD

Manhattan Plastic Surgeon
+1

Previous Capsular Contracture from Under the Muscle. Should I Go over the Muscle or Do Fat Grafting?

If you are happy with the volume of your existing breast tissue, I would recommend that you have a revision mastopexy where your own breast tissue can be moved to a higher position to give you the upper pole fullness you need, as well as decrease the distance from the nipple to the infra-mammary fold.  If you want fuller breasts, you will still have risks of capsular contracture, as that is the nature of implants; you can consider fat transfer, however from your photo, you appear thin,... more
Amy T. Bandy, DO

Newport Beach Plastic Surgeon
+1

Fat grafting and breast lift will work

You have mild Pseudo ptosis and also loss volume in upper pole of the breast, The combination of the fat grafting and mastopexy will give the best result.  Please make sure that your plastic surgeon is qualified to do the large volume fat grafting . You will need about 300 cc of fat grafting each breast.
Kamran Khoobehi, MD

New Orleans Plastic Surgeon
+1

You have significant bottoming out of your breast tissue, to improve your breast you need a breast lift with or with out implant

Your breasts in the photos show a high ridding nipple areolar complex in relationship to your breast mound. Most of your breast tissue seems to have migrated below your nipple or as Dr. Baker has questioned, you have had a mastopexy, breast lift, with your nipple being placed too high. Fat grafting is a great new technique to enlarge your breasts but will not correct the position of your nipple. From what I see in your photos, you would be best served with a breast lift to reduce the breast... more
Carl W. "Rick" Lentz III, MD

Daytona Beach Plastic Surgeon
+1

Prior Capsular Contracture

New implants will again be at significant risk for contractures, but one never knows. If you choose to have implants again, I would place them below the pectoral muscle. The picture suggests that you may  have had a breast lift.  Without or with an implant, your shape could be improved with further skin tightenting, i.e. a secondary breast lift, or a primary lift (if you never had one), esp. on your left side. You might try this first before taking another... more
Stephan Baker, MD

Miami Plastic Surgeon
+1

New implants after previous contracture

Without seeing you personally, no one can make a definitive recommendation, but I do have another option that would be worth considering: go under the muscle and use Strattice grafts for an internal bra. My expreience is that Strattice is very effective at preventing capsular contracture, and it would add support for the implants as well.
Richard Baxter, MD

Seattle Plastic Surgeon

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