Revision due to Grade 2 Capsular Contracture. Want to get a revision but not sure what type of implant to go with.

Question

I got a Breast Augmentation the Spring of 2015. Dual plane 400cc in one breast and 375cc in the other moderate plus smooth silicone round mentor implant. I have been diagnosed with capsular contracture grade 2 by my surgeon. They are firm and do not have a natural breast slope. My doctor is an excellent surgeon with my happy patients. Unfortunately cc happened to me. Looking to do a revision but not sure if I should keep the same type of implant or if I should do a textured or even go to saline?

Harry T. Haramis, MD, FACS · Answer

Capsule contracture can be unpredictable and very frustrating. You may benefit from an adm such as  Strattice with removal of the capsules and new, similar smooth round gels.An exam and consultation with your/a plastic surgeon is recommended to discuss your options and expectations.

Jed H. Horowitz, MD, FACS · Answer

It is certainly possible to #increase your implant size with a #revision. However, the #pocket will need adjustment and a lift may be necessary; to better #support the new implant. Additionally, a mesh for further support may be helpful depending on the #implant size and skin #elasticity.

With both implant types there are choices when it comes to size, shape, and profile. The criteria best to suit you will be discussed in full detail at your breast augmentation consultation. Any cosmetic #revision has risks of unhappy outcome or other complications. Also, the right implant for the revision is contingient on shape of body and your desired outcome.  Your procedure should always be performed by a #PlasticSurgeon who is board-certified and has a great deal of experience specializing in cosmetic #surgery. You will then greatly improve your chances of getting the result you desire, and, without the need for another revision surgery. It is suggested that you look at before and after photos of the surgeons actual patients, and read patient #reviews. Gathering all of this information will help you make a well-informed decision.

Shlomo Widder, MD · Answer

Dear Sassy,   Front and side view pictures would have been very helpful. Without picture or physical exam it is difficult to give you appropriate recommendation.   If you have some motion of the implants - capsule contracture level 1 or 2, all you need is capsulotomy  (scar release). That will open up the pocket, soften it up and give a nice slope. You do not have to change the implants with this condition.   If your breasts are very firm with no motion of the implants - capsule contracture level 3 or 4, you have most likely "Biofilm" (bacteria embedded in the capsule and on the implants), which requires capsulectomy (excision of capsule ) and replacement of implants to avoid recurrence.     In my 29 years o practice, I have noticed that almost exclusively, 'Biofilm" involves only one side. I have never seen bilateral "Biofilm", which is good news for you , because you might need only capsulotomy.   If you do need to replace your implants, I would recommend saline implants, which, statistically have less capsule contracture associated with them. Another critical thing that I instruct my patients to do , in order to reduce capsule contracture,  is implants displacement massage.   Always, consult with experienced board certified plastic surgeons who operate in accredited surgery center for your safety. Most importantly, check the before and after pictures in the photo gallery, to make sure that they are numerous, consistent and attractive with nice cleavage, perky, symmetrical and natural looking.                 Best of luck,                                       Dr Widder

Asaad H. Samra, MD, FACS · Answer

Great question, but unfortunately there isn't just one answer. In light of the contracture, I would recommend removing as much the capsule as possible. A textured implant may help in the subglandular plane, but in light of the submuscular plane that you also have may. It be necessary. An acelluar dermal matrix, or ADM, may also be helpful in preventing further contracture. Speak to your PS about it. Best of luck.

Steven Wallach, MD · Answer

If you have a capsular contracture, it would be best to try to remove as much of the capsule as possible, exchange the implants( i prefer smooth under muscle) and consider an ADM.

Kenneth R. Francis, MD, FACS · Answer

Dear Sassy,I would first question your diagnosis of Grade II capsular contracture.  A grade two contracture is one that, by definition, can only be felt, but is not visible.  It generally does NOT require any correction.  If your contractures truly require treatment there are several options.  The best of these options is probably capsulectomy (removal of the capsules), exchange of the implants with textured devices, submuscular placement if possible using a no touch, Keller funnel technique and placement of an acellular dermal matrix product.  This course of action would incur significant additional cost and risk.  There are less expensive and less risky options that should be discussed with your plastic surgeon.  Good luck!

Tom J. Pousti, MD · Answer

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). It will be in your best interest to have this conversation with your surgeon. I hope this, and the attached link helps.

Revision due to Grade 2 Capsular Contracture. Want to get a revision but not sure what type of implant to go with.

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