I had breast implants put in when I was 19 (I'm now 36). I almost instantly started forming the capsule. I want to have them repaired but every surgeon I've talked to has suggested a totally different technique. One doc said we'll go over the muscle and that we CANT go under muscle now that I created a pocket with current implants. One said under the muscle. One said drain, one said no. Question is: Can I go under muscle and not have capsules fully scraped out?
Repairing Capsular Contracture? (photo)
Doctor Answers (7)
Treating Capsular Contracture
The various opinions that you have received reflect the differences of opinion that exist within the plastic surgery community. In part this is a result of our inability to determine the exact cause of capsular contracture. There are a few variables that we can control. One is the location of the pocket (submuscular or subglandular), another is the type of implant (saline, silicone, smooth or textured) and a third is our handling of the capsule itself (scoring, partial removal or complete removal). The general consensus is to change some of these variables by either changing the pocket from subglandular to submuscular or removing some or all of the capsule. A new implant should be utilized and I prefer to use a drain although that is a matter of personal preference. Use of acellular dermal matrix may prove to be valuable although it is expensive. Try to understand the rationale for your doctor's recommendations and then proceed with whom you feel most comfortable.
You did not mention if the current implants are over the muscle or under. It is very difficult if not impossible to replace an implant under the muscle if it was originally placed on top. You are right that you will get different opinions. Every surgeon has a different experience and bring his expertise to the table when consulting with a patient. The only advice I can give is to have at least three consultations with well experience board certified plastic surgeon and ask a lot of questions. May be then you will feel comfortable with one of the recommendations.
Capsular contracture and treatment
Each doctor has his/her own way of doing things, and no one way is the right way. You have to go with what you feel comfortable with from what the doctor's are telling you. Good luck.
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There Are Different Options for Treating Capsule Contracture
I can understand that you may be discouraged or confused when you hear experts offer different opinions on the best way to treat your capsule contracture.
You are right to seek second opinions and reconcile the differences.
There are numerous options and after reviewing your history and examining you, surgeons with experience and expertise will choose what they believe to be the best procedure for you. Unfortunately, there is no one right answer, upon which all surgeons will necessarily agree. Surgeons will use knowledge from clinical studies and integrate that information with their own clinical experience.
Among the considerations for treating capsule contracture:
- score the old capsule to expand the space (pocket) for the implant;
- remove the old capsule, partially or entirely;
make a new pocket for the implant;
- move from subpectoral to prepectoral or vice-versa;
change the implant;
- consider a textured surface implant
- consider a saline implant
- use of ADM (acellular dermal graft);
- use of a medication regimen including anti-inflammatory medications;
- remove the implants.
Your best advice is to do your research and find a doctor deserving of your trust and confidence and have a thorough discussion of the alternatives, leading to a conclusion and practice with which you feel most comfortable.
Submuscular placement reduces Capsular Contracture Risk.
Studies have shown that submuscular placement reduces Capsular Contracture Risk. However, it does not reduce that risk to zero. The only reason that you may not be a candidate for submuscular relocation is if you previously had implants place in that location and the pocket is completely scarred down. Further, there is increasing evidence to show that placement of acellular dermal matrix significantly reduces recurrence of capsular contracture. With respect to existing capsules, my opinion is that as much of the old capsule should be removed as possible.
Capsule contracture treatment
All the treatments that you mentioned are considered "acceptable", you could also consider using an ADM (acellular dermal matrix). The options may be confusing to both patients and some doctors as well! I would seek the option of an experience plastic surgeon and see examples of his work...there is not one right answer for you.
Repairing Capsular Contractur
There are many techniques in use for capsular contracture. I think it is best in this setting to put the new implants under the muscle. If the capsules are not calcified or otherwise so thick that they cannot be made to lay down without irregularity, they can be left in place and will provide added padding to the breast. You may need to see a few more surgeons until you find one who feels that that approach is acceptable.
Thanks for your question and for the attached photo. Best wishes.