For 4th Surgery, Should I Removing an Encapsulated Saline Implant and Replace W/ 'Gummy Bear' Implant?

47 yr old, healthy with recurrent encapsulation in right breast. I am considering a 4th surgery to replace my saline, submuscular 350cc implant with a cohesive silicone, gummy bear implant. Am I wasting my time and need to just explant? which I do not want to.

Doctor Answers (7)

Time to bail out

+2

When patient comes to me at the age of 47 has had four operations on her breasts the immediate question must come into mind, "when do we stop this." Your financial and psychological investment in the previous procedures has been substantial and the change and adjustment without implants might be difficult. But it appears that you are on the train of no return, destined to repeat these surgeries. It takes an honest surgeon to tell you this, and an experienced surgeon who realizes that after four operations is very little that he or she can do. It appears that your body forms capsules around the implants, and will continue to do so.


New York Plastic Surgeon
4.5 out of 5 stars 11 reviews

For 4th Surgery, Should I Removing an Encapsulated Saline Implant and Replace W/ 'Gummy Bear' Implant?

+1

Sorry to hear about the complications you have experienced. Capsular contraction can be a very frustrating complication for both patients and surgeons.  In my practice, I have found the most success treating these difficult problems utilizing techniques such as sub muscular pocket conversion (if relevant), capsulectomy, use of fresh implants, and the use of acellular dermal matrix.  Acellular dermal matrix is a biologic implant that carries the ability to become integrated into native tissue. It is made by taking a full thickness section of skin from a donor source ( human, porcine, or bovine in origin).  I hope this, and the attached link ( demonstrating a case utilizing acellular dermal matrix) helps. 

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 759 reviews

Explant and then later replace implants

+1

Hello,

If the encapsulation is persistent, you might consider explantation followed by an interval without implants. This frequently allows the tissues to soften allowing implant replacement later. Not everyone will go for replacement later of course.

 

It is a choice. :)

 

Best Regards,

 

John Di Saia MD

John P. Di Saia, MD
Orange Plastic Surgeon
5.0 out of 5 stars 23 reviews

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Recurrent capsular contracture

+1

Recurrent capsular contracture is a difficult problem. The best regimen I have found us complete capsulectomy, implant exchange and a placement of acellular dermis like Strattice. The data is currently anecdotal but very strong. There are a number of peer reviewed articles now showing the benefits of this approach 

Jason Pozner, MD
Boca Raton Plastic Surgeon
4.5 out of 5 stars 25 reviews

Recurrent capsular contracture and options

+1

Dr Sherman makes very good points below about when to say enough is enough. It is difficult for you as a patient with additional expense, recovery time and then the emotional let down with a recurrent capsular contracture.

I have personally had good experience for recurrent capsular contracture patients with the use of an acellular dermal matrix such as Strattice. This is a materiel derived from porcine (pig) skin that allows a new coverage for at the least a portion of the implant  and early studies have shown a decreased ability for the body to reform a tighter capsule. There is no replacement for an in-person consultation with exam so my recommendation would be to see a plastic surgeon with experience with experience with these products. This is an important decision so I recommend you see the new plastic surgeon with questions in hand.

I hope this helps.

Dr Edwards

Michael C. Edwards, MD, FACS
Las Vegas Plastic Surgeon
5.0 out of 5 stars 11 reviews

Consider implant removal and fat grafting

+1

As the surgeons before me have indicated; after multiple recurrences of capsular contracture, you should seriously consider removal of the implants. But all is not lost, I routinely perform fat grafting on women who have had implants removed after complications, with excellent results.

Jeffrey Hartog, MD
Orlando Plastic Surgeon
4.5 out of 5 stars 42 reviews

Multiple capsular contractures

+1

Some folks do not respond well to implants and their bodies repeatedly make capsular contractures.  Saline below the muscle has the lowest rate of this and silicone is higher.  So you already have had the best chance of success and it failed.  Strattice or Alloderm is getting some press about reducing capsules but this is just anectodtal at this point and not something to base your decisions on.  Maybe either leave them alone or take them out.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
5.0 out of 5 stars 50 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.