Using the Same Implants After Capsular Surgery and Fat Grafting?

I had a breast lift with 375 cc silicon implants. The past 3 months my right breast got hardened and hardened. my original surgeon is uncooperative . I had a consultation with another surgeon recommended by a friend. He would do the capsular surgery by removing the implant, removing capsule and put the implant back. He explained that my implants are perfectly ok, not even a year old and I'm happy with the size. He wants to do fat grafting around both implants. Any thought on that? Thank you!

Doctor Answers (18)

New implant needed after capsulectomy for contracture

+1

While some causes of hardening (capsular contracture) such as post hematoma, do not theoretically require a new implant, most prudent plastic surgeons would recommend a change. You want the best chance for success! As far as fat grafting is concerned, there has to be a reason they were suggested by your surgeon. This reason can be for contour improvements or coverage of palpable implants, but not for capsular contracture prevention.


Naples Plastic Surgeon
5.0 out of 5 stars 2 reviews

Implant Replacement and fat grafting

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As other surgeons have answered previously, and for the same reasons, I think it is a good idea in general to use new implants when doing a capsulectomy.

Fat grafting is a good idea in my opinion, particularly if your tissues covering the implant are thin, particularly on the side and on top. Though fat grafting has not been proven to improve or prevent capsular contracture, there are definitely a number of cases that have been reported that demonstrate improvement. Also thickening the tissues with fat grafting may help provide more padding over the implant. The benefit of this is you will be able to feel the implant and any rippling less, and it may make any slight capsular contracture less noticeable. If the surgeon has experience with fat grafting you need not worry about free fat in the implant pocket, particularly if the fat grafting is done before the implant is changed during the procedure.

Jeffrey Hartog, MD
Orlando Plastic Surgeon
4.5 out of 5 stars 43 reviews

Capsular contracture surgery, implants, and fat grafting.

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The implants may be fine, however reusing your original implants not only violates the implant warranty but may retain the cause of your contracture in the first place (biofilm). Treatment usually requires capsulectomy (removal of the capsule), exchange to new implants, possible drain placement, and post-surgical massage. I'm not sure why your surgeon is recommending fat grafting. There is no data to show a lower contracture rate with fat grafting, and if the grafted fat gets into the implant space then you may be at a higher risk of infection and recurrence of a capsular contracture. If the proposal for fat grafting is to decrease rippling or implant show, then wait 6 months prior to grafting to be sure the contracture has not recurred.

David Bogue, MD
Boca Raton Plastic Surgeon
5.0 out of 5 stars 12 reviews

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New surgery might be avoided/ una nueva operacion podria ser evitable

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the new treatments against  capsule contractions vary between  ultrasound with topical gel imiquimod 3 sessions  a week  during  2 weeks plus montelukasts 20 mgrs  3 times a day during 1 month and you will fulfill the contracture ,avoiding succesful a new surgical reintervention

los nuevos tratamientos con ultrasonido topico mas imiquimod  combinado con montelukast  20 mgrs  3 ves al dia por un mes  evitarian la necesidad de una nueva operacion

Ramon Navarro, MD
Mexico Plastic Surgeon

Using the Same Implants After Capsular Surgery and Fat Grafting?

+1

Hi, thank you for your question.

As other doctors have said, Breast Implants are single used devices and should not be put back in for capsular contracture.  You want to remove the old implant and the entire capsule.

As far as the fat transfer goes, I do it all the time but would not recommend doing it at the same time.  It has not been shouwn to decrease capsular contracture.  The only reason would be to add more volume over the implants.  If you are happy with the size and the other breast is soft, you probably don't need fat at all once the capsulectomy is performed.

Rigo Mendoza, MD
Tampa Plastic Surgeon
4.5 out of 5 stars 26 reviews

Unilateral capsule

+1

I would not be uncomfortable doing this.I tell patients every ne gets a capsule.The key is to keep it soft.Whether the injection of fat into the area will help is not known but it could help by providing more soft tissue.

Robert Brueck, MD
Fort Myers Plastic Surgeon
5.0 out of 5 stars 26 reviews

New Implants are Necessary with Capsular Contracture

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Capsular contracture is a phenomenon that an internal scar forms vigorously around an implant. The are several theories as to why this occurs.  One main theory revolves around a film of bacteria on the surface of the implant itself.  Based on this possibility, I do not use the same implant when performing a capsulectomy, site change and reaugmentation. 

Dr. ES

Earl Stephenson, Jr., MD, DDS
Atlanta Plastic Surgeon
5.0 out of 5 stars 9 reviews

Best Treatment of Capsular Contracture

+1

Hello,

I am sorry you are having problems with your surgical results, and that you apparently have capsular contracture.  It's a shame you and your original surgeon are not communicating well, either.  However, I am dubious of your new surgeon's recommendations.  Recurrent capsular contracture after treatment for capsular contracture is higher than after the original surgery, so it is important to do all that you can to thoroughly treat it in the first place.  This includes removal of the entire scar capsule in one piece along with the implant, and replacing that implant with a new implant.  The cause of capsular contracture is bacterial, and replacing the old implant with it's contaminating biofilm will ensure re-contracture.

Although I don't have photographs, or the benefit of a physical exam, fat grafting to your breast seems inappropriate if you already have implants and a breast lift.  Additionally, it is not a well established procedure for cosmetic augmentation of the breasts.

I would visit Tracy Baker, M.D. in Miami or head north to Atlanta to see Mark Codner, M.D.

Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.5 out of 5 stars 33 reviews

Early contractures

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can happen but why is your original surgeon being uncooperative?  Doesn't your surgeon realize with social media that you can  post your experience with his/her name attached to it and say anything truthful that you like.  Assuming you cannot rectify the problem with your original surgeon, reusing implants is certainly an acceptable practice, especially if dealing with your first episode.  However, if you do have repeated problems with contractures and you wan to do EVERYTHING you possibly can to resolve the problem, new implants, new pocket and possibly texturing are all things that can be done in attempts to resovle your problem.  Best wishes...

Curtis Wong, MD
Redding Plastic Surgeon
4.5 out of 5 stars 17 reviews

Using the Same Implants After Capsular Surgery and Fat Grafting?

+1

There are many theories as to the cause of capsular contracture.Therefore there are many theories as to the teratment

These include

1 Capsulotomy ( release of the capsule)

2Capsulectomy ( Ecsision of the capsule)

3 Keeping the original implant

4Excahnging the implant for the same type  ,smaller volume implant,or  changing to a textured or an adjustable implant

5 Placing the implant in a different pocket 

6 Treating the capsule with injectable cortisone,, fat injection,placement of acellular dermis or mesh. 

7 Maintaining post operative expansion of the pocket for several months with an adjustable implant, then reducing the volume

8 The Use op post operative medications, massage ultrasound ,and compressive garments

Depending on your particular circumstances ,a treatment program will be devised for you using a combination of these options

 

 

 

 

Hilton Becker, MD
Boca Raton Plastic Surgeon
5.0 out of 5 stars 6 reviews

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.