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Putting Back the Same Implant After Capsulectomy?

I had a Brachioplasty and Breast Lift with implants this past Septemeber. My right breast now has a painful Grade IV contracture resulting from a hematoma. To make matters worse, the particular model of Mentor cohesive gel implants that I have are not yet approved in the US.

My local surgeon wants to perform a capsulectomy and just replace with the SAME implant. I mentioned to him that everything I read indicated standard practice was to replace with a new implant. He said that I would be fine since I hadn't had the implant in very long. I am very indebted to him because he was willing to consult with me when other surgeons blasted me for going overseas. They could care less that I had lost 169 lbs and had debilitating excess skin. My Costa Rica surgeon told me to come back so he can perform the capsulectomy and replace it with a new implant, however, I'd like to avoid travelling back to Costa Rica if at all possible.

What should I do at this point? Any advice would be helpful! I am almost positive this hematoma occurred as a result of strain and is not ruptured. Yet and still, should I be leery of my US surgeon wanting to replace with the SAME implant?

Asked 37 months ago by jcandace in dallas, tx

Tags:

capsular contracture

So many options for capsular contracture

The real problem is we really cannot definitively identify the cause nor can we provide a consistent recommendation regarding the management of capsular contracture. In my mind you have a few options and of course some of this is based on my personal practice experience over 15 years now: My most consistent and reliable method of treating capsular contracture is capsulectomy and implant replacement with a NEW implant. Capsulotomy/partial removal and replacement with the EXISTING implant... more

Otto Joseph Placik, MD

Chicago Plastic Surgeon

ASAPS ASPS

No right answer

I would personally not agree to perform surgery on a patient unless I had backup implants available. That is not to say it is wrong, just my opinion. What if during surgery an infection was discovered? Or a damaged implant? Or something bizarre, like an inferior quality implant? All these things are possible, and have happened. Now the patient is asleep and the surgeon is faced with an insoluble problem. If you are enamored with the implant shape, and cannot find an implant shape in... more

Brent Moelleken, MD

Beverly Hills Plastic Surgeon

ASAPS ASPS

OK to keep the same breast implants if your plastic surgeon says so

This is something that your plastic surgeon has to use his best judgement on. In a perfect world, inserting new implants would be the ideal thing; however, silicone implants are expensive and you would have to bear the cost. There is probably nothing wrong with the implants you have in, and as long as they are intact and kept in a sterile field, putting them back in should not be an issue. The implants themselves are not the cause of the capsules. New ones would not solve the problem. more

William B. Rosenblatt, MD

New York Plastic Surgeon

ASAPS ASPS

A mixed bag

I agree that there is no "standard" practice in this situation. I feel that the hematoma led to the contracture. It is probably better to use a new implant with the capsulectomy. Mentor also likely has a suitable legal replacement as well. If your surgeon feels that it would be ok, he does have the benefit of examining you. If you are concerned about a ruptured silicone implant, MRI will answer the question. If you doubt your surgeon, please, by all means, seek a second... more

Scott E. Kasden, MD

Dallas Plastic Surgeon

ASAPS ASPS

Silicone gel breast implants can last ten years or more

I am sorry that you had to go abroad in order to afford corrective cosmetic surgery after your extraordinary weight loss. This globalization of healthcare has affected patients requiring cosmetic surgery, hip replacement, and even heart surgery. I am also sorry to hear that you had difficulty finding a surgeon to treat you after you developed a complication. You have had so many good responses and I can only add that I know of no "standard" to replace an implant after... more

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Peter E. Johnson, MD

Des Plaines Plastic Surgeon

ASAPS ASPS

Replacing breast implants

I agree with Dr. Moelleken that any surgery around an intact implant where the end result includes having an intact implant in place should have implants available. In my practice we believe that a major cause of capsular contracture (hard or firm breast implants) comes from subclinical bacterial contamination. To reduce the possibility of this happening again, we would recommend the implants being replaced (the biofilm on the old implants may be impossible to sterilize). That is not to... more

Doctor's Website

Steven H. Williams, MD

San Francisco Plastic Surgeon

ASPS

It would be best to change the breast implant

It is possible that the hematoma did lead to your capsular contracture; however, there are other possible causes as well. A subclinical (non-obvious) bacterial infection around the implant could have contributed. If this is the case, a film (thin layer) or coating may exist on your implant and potentially induce another capsular contracture if you replace the same implant. Although the cohesive gel implants are not yet FDA approved in the U.S. and available to all surgeons, there are... more

Sanjay Grover MD

Orange County Plastic Surgeon

ASAPS ASPS

Change implants and remove the entire capsule

Revision breast surgery is challenging, especially in the setting of a rapid onset severe contracture. Without examining you personally, offering a specific recommendation is not realistic... given that, here are a few thoughts. Given the rapid onset of your contracture, changing implants would be indicated (in my opinion). Start with everything fresh. Performing a complete capsulectomy as opposed to capsulotomy is important. That means removing all of the capsule (scar tissue) as opposed... more

David L. Kaufman, MD

Folsom Plastic Surgeon

ASPS

Implant not the problem

No comment about going overseas, but if the problem is unilateral and you are happy with the opposite breast, then there is no need to replace the implant if the etiology is a hematoma, not an infectious process. Whoever does the surgery should however prepare you and the surgery for the event of a need for replacement since one never knows what one will find. Even in the States, the implant a patient has may not be what a patient thinks she has.

Robin T.W. Yuan, MD

Beverly Hills Plastic Surgeon

ASPS

Capsular Contracture

WIth grade IV capsular contracture, many insurnace companies will actually pay towarsd your treatment. I would personally perform a capsulectomy with use of new implants. I would not use old implants again since they may harbor a biofilm of bacteria around them that can result in capsular contracture again.

Siamak Agha, MD, PhD

Orange County Plastic Surgeon

ASPS

Capsular contractures are a tough problem

I agree with the comments already made to you. It is possible that you have a Style 410 implant from Allergan or an implant made by Silimed. The Allergan Style 410 is a shaped, textured gel filled implant. This style is not yet available in the US but is currently available in Canada. There is information available on the internet about the Style 410. Whenever a patient gets a capsular contracture only on one side the immediate question should be, "why only one side and not... more

Jeffrey Zwiren, MD

Atlanta Plastic Surgeon

ASPS

Re-explore with contingencies discussed beforehand....

Hello, There may be a number of things going on in the setting of a rapid development of contracture and infection is included. Seeing as you are perhaps going to a new surgeon, he may or may not know much of the surgery that preceeded the one he is offering you. You need to be re-operated with a good discussion beforehand with your surgeon about what you want done if certain things are found: (1) Infection - You really should remove the implant and not repalce it for a while to allow the... more

John P. Di Saia, MD

Orange Plastic Surgeon

Yes it is ok to keep the same breast implant

I'm sorry to hear that you have a bad capsular contracture so soon after your procedure. It is very likely related to the hematoma. If your surgeon feels that the implant has not ruptured, then it is perfectly ok to remove the implant, remove the capsule, and then replace the SAME implant. This is a very common practice. Even if the implant were older, it would be a safe procedure to keep the same implant. Your situation is a little different in that your implant is not available in the US... more

Sirish Maddali, MD

Portland Plastic Surgeon

New vs old breast implant

Your implant is almost new so assuming that it appeared normal during the capsulectomy it would not be unreasonable for your surgeon to use their judgement and re-use it and save you the money. However, that is "technically" not the right thing to do even though many surgeons would do it that way. The clean answer is to put in a new implant.

Richard P. Rand, MD, FACS

Seattle Plastic Surgeon

ASAPS ASPS

Reinsertion of breast implant is alright

J, It is alright to reinsert the same implant. Many surgeons have done this on many occasions, so it is not a deviation from accepted practice. The implant will be kept on a sterile field and will likely also be washed in an antibiotic solution. When I am faced with this scenario in my practice I have my patients agree to a contingency plan in case the implant cannot be reinserted, e.g. a ruptured or leaking implant. There is a wide variety of implant dimension available in the U.S. and... more

Kenneth R. Francis, MD

Manhattan Plastic Surgeon

ASAPS ASPS

Breast implant replacement and a capsular contracture

I prefer as common in my practice is to replace the implants when I perform a capsulectomy. I think that if the theory is that the capsule formed from a subclinical infection, then the implants are technically contaminated and should be replaced.

Steven Wallach, MD

Manhattan Plastic Surgeon

ASAPS ASPS

If you replace one implant you may need to replace both

It sounds like your surgeon would perform a capsulectomy and replace it with the same implant. If he or she feels that is appropriate then I would follow his advice. It is not the implant that is having problems. The capsule may have been the result of a hematoma as you suggest. The problem with replacing the implant with a new one is that you would have two different implants, since the ones you got in Costa Rica are not approved for use in the USA. The new implant placed in the US may... more