Standard Practice to Remove the Capsule for Capsular Contracture During Revision Surgery?

I've had a 2nd opinion that at least 1 of my implants is CC'ing. I'm due for rev. sx for a lift & was told the capsules need to come out if they are. I'm on Singulair, take Vit. E & massage. My surgeon says he never removes the capsule even if it's CC'd. He just opens it by splitting it in 1/2 before inserting new implants. He said it's very bloody & unnecessary to remove it. Is it standard procedure to leave the cc'd capsule in or take it out? I have under the muscle, smooth, silicone implants.

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18 Doctor Answers | Asked by swimchick in San Francisco CA

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Standard Practice to Remove the Capsule for Capsular Contracture During Revision Surgery?

Removing the capsule has a higher complication rate such as bleeding and thinning of the tissues compared to capsulotomy (releasing or scorring the capsule) A new capsule forms anyway when a new implant is placed I therefore tend to leave tha capsule unless it is thickened or calcified I will use an adjustable implant in recurrent cases ,where after capsule release I temporarily overexpand the capsule and then release it to the optimal size later

When to do capsulectomy after breast capsular contracture?

This is a tough question to globalize: every case is different. In general, it this is the first time the breast capsule has contracted and the implant is above the muscle, one can do a capsular release only and place the implant below the muscle. If the implant is below the muscle and the contracture is mild, I may do capsulotomy only. If this is the second time or more the capsule has contracted, then the capsule should be removed.

How to treat a capsular contracture?

I do tend to remove the capsules in my patients with capsular contracture, but if the implants are under the muscle, I do usually leave some of the capsule attached to the ribs. Sometimes, though, I do leave the capsule, but I put the implant in a new plane of dissection just above the capsule (a "neosubpectoral pocket"). Regardless of the method, I do think it's important to place the implant into a mostly virgin space, not just put a new implant back into the same... more

Capsular contracture treatments.

Capsular contracture is present in ~25% of breast augmentation cases and may be attributable to known causes such as infection (overt or subclinical), hematomas, or persistent seromas. Many times, the reason for capsular contracture is unknown. It can present as early as a month postoperatively or several years later. Treatment begins with conservative methods such as massage, ultrasound, anti-inflammatories, etc. However, surgery is the mainstay of treatment for recurrent contracture. The... more

David Bogue, MD

6 reviews

Boca Raton Plastic Surgeon

www.drbogue.com

Treatment of capsular contracture

Capsular contracture with silicone implants, usually requires removal of all or most of the capsule. The capsule has typically shrunk down around the implant and requires removal in order to re-insert a new implant. Also, the capsule may have some biofilm of bacteria, which has on the old implant, and this needs to be removed. Best wishes, Dr.Bruno

Remove capsule to treat capsular contracture?

Great question. Whether or not to remove the capsule depends on why you are having the revision. If you are having increased firmness of the breast due to the capsular contracture, it makes sense to remove at least some of the tissue that is causing the firmness (the capsule). If your breast shape is altered due to the capsular contracture, your surgeon can either cut or excise some of the capsule to improve the shape. Removing the capsule does cause bleeding at the time of... more

Treatment of capsular contracture (revision breast surgery)

The answer to your question is multifaceted since it depends on the location of the capsule and its severity. If I am dealing with a significant capsule that has resulted from a leaking old silicone prosthesis (placed in the 70’s), then I would perform a total or subtotal capsulectomy. That capsule is usually calcific and has a egg shell texture. If you leave it when replacing the prosthesis to a new position, generally submuscular, you run the risk of either seeing or feeling the... more

Capsular contracture

The treatment varies for capsular contracture. Some surgeons remove the entire capsule if possible, and place the implant in another pocket plane.

Steven Wallach, MD

12 reviews

Manhattan Plastic Surgeon

Sometimes

This is a complicated topic. Since the implant is under the muscle, it is very difficult to get the capsule off of the ribs and the muscle. I will do a partial capsulectomy. A relatively new concept is to find virgin territory by leaving the capsule in place and opening a space between the upper part of the capsule and the muscle to put the implant. Another option for virgin territory is to put the implant on top of the muscle. By moving the... more

Treatment of Capsular Contracture

There is no standardized treatment for CC. It generally involves some type of pocket adjustment. This can be creating a new pocket behind the muscle and moving the implants behind the muscle if they are subglandular, or removing the capsule to create a "new" space behind the muscle(capsulectomy). Acellular dermis presents a promising alternative for treatment of CC if the implants already behind the muscle, but is costly. Another alternative is a... more