Best Revision Option for Aesthically Pleasing, Symmetrical & Lasting Results After a Grade 4 Capsular Contracture? (photo)

I'm 33 & had my augmentation at 21 (5 years after pregnancy & breast feeding) & am seeking a revision due to a grade 4 capsule in my left breast. I have seen 5 surgeons so far and am finding it difficult to make a decision about my best option for revision - removal & uplift, replacing under the muscle, conical implants & fat transfer have all been suggested. I have been told my skin is very thin and I have little breast tissue, my implants are 300cc silicone overs, many thanks for your help.

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7 Doctor Answers | Asked by MissJones in London, England

Doctor Answers (7)
Community Comments (2)

Best way to deal with advanced breast contractures

Really depends on what YOU want. If you're content to return to your pre-augment size, then an explant/lift is best. If you still want an augmentation and want to minimize the risks for another contracture, are you willing to accept the effects of a submuscular augmentation? And if you're wanting perky, the scars of a lift? Having a thin skin coverage certainly points you towards gel implants and you could subsequently choose to have a textured anatomic implant... more

Curtis Wong, MD

7 reviews

Redding Plastic Surgeon

Best Revision Option for Aesthetically Pleasing, Symmetrical & Lasting Results After a Grade 4 Capsular Contracture?

I recommend removal of the saline implants, removal of all capsular elements, and place a silicone implant under the muscle followed by Strattice to cover the lower portion of the implant. this will give you the best result and least possibility of a capsule recurring.

Breast revision and implants

Just from your photos, it looks like you may be a good candidate for implant exchange and a lift. With little soft tissue coverage, under the muscle may be better. You will get many different opinions from different doctors.

Steven Wallach, MD

12 reviews

Manhattan Plastic Surgeon

Improvement of capsular contracture over the muscle

Thanks for your question. There is certainly no replacement for an in-person consultation and examination. In general I believe you would benefit from removal of your saline implants and probably part or all of the associated capsule (scar around the implant). I would then recommend lifting up the chest muscle so a partially under the muscle pocket can be created for better upper middle breast coverage. This would be followed by a full breast lift to allow the lifted breast tissue to better... more

Best Revision Option for Aesthically Pleasing, Symmetrical & Lasting Results After a Grade 4 Capsular Contracture? (photo)

You have seen several plastic surgeons and have been given many option .There are two others to consider 1 Use of an adjustable saline implant to over expand the capsule and then reduce the volume several months later 2 Remove the implants and do a lift. Scarring can be kept to a minimum by using a circum-areolar incision

Strattice for capsular contracture revision

Capsular contracture revision in cases like yours appears to be can be challenge. While no one can give you specific advice without seeing you personally, there are some general guidelines. First is removal of the scar capsule and a new implant. That will unfortunately thin the tissues even more, so an acellular matrix graft such a Stratttice provides new reinforcement, support, and coverage. Think of it as an internal bra. This could easily be done along with placing the new implant under... more

Best Revision Option

Thank you for your question and for the attached photos. The photos are very helpful, but pale in usefulness when compared to an in person examination. With the available info, I would suggest removing these implants and the capsules, and placing the implants under the muscle. You may wind up needing a lift, but with the capsule removals, adding the additional lift incisions may compromise the blood and nerve supply to the nipples and areoalas, so I would wait and do the lift if... more

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Comments (2)

Natural Liv 4 Feb 2013

I'm also 33, mom of 3 and breastfed them all, I had 525cc implants removed 6 weeks ago and not replaced. I am sorry to see all these dr's suggesting more implants for you... You can look at my surgery photos and see the results.

MissJones 4 Feb 2013

Thanks for your reply. I also breastfed for a year but prior to having implants and 4 years later my skin had not contracted and I had very saggy, empty breasts. I think in part I just hadn't finished developing before I became pregnant - my daughters 17 now and still growing. My main worry about explant is I know the likelihood of my skin contracting is very small because of the poor elasticity before my BA, and now 13 years later of course they have sagged even more. It's such a hard decision because the capsular contracture has been hard enough to deal with - the thought of going through surgery and being left with even less attractive breasts would be very psychologically hard for me to deal with and I am trying to explore all the available options to get the best possible outcome in the long -term - and it feels almost impossible to come up with the right answer. At the moment I am looking at explant and fat transfer but finding a surgeon I feel I can trust is proving just as difficult as making the decision in the first place. Again, thanks for your reply, hopefully I'll get there in the end : /

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