1-yr Post Op Lift w/Implants. Poor Results. Revision but Scared of 2nd Capsular Contracture

I'm scheduled for a revision next month. My lift with silicone implants subglandual resulted with severe capsular contracture on left breast. Dr had done several manual release till breast got soft. Since right breast was always smaller, dr gave 350cc on right and 300 on left. Now, left breast is smaller, dented at vertical scar. Dr wants to remove implants, switch them to the other breast, and do another tuck at vertical scar. This time I am really scared of 2nd cap cont. Under muscle too $$

Doctor Answers 7

Capsular contracture risks

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Once you have a capsular contracture once, you are at a greater risk of having another, so I understand your concern. It sounds like the capsular contracture has failed improvement with massage. In that case it does sound reasonable to proceed with removing part or all of the capsule, and changing the implants position to below the muscle. The risk of capsular contracture is less when placed below the muscle. Also, if part of the reason you dislike your results is due to an inadequate lift, your surgeon will have the opportunity to address this as well. If you do not feel comfortable with your surgeon, you can always seek a second opinion. Good luck!

Breast implant revision

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Without an exam or at least seeing photos it is difficult to say what you would need.  A revision sound reasonable.

Revision augmentation mammaplasty

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Implant removal and replacement surgical procedures generally have a higher rate of complications including capsular contractire when compared to primary augmentation. Having said that, it depends on the degree of the asymmetry and how much it truly bothers you and not the surgeon.

Revision of breast lift with augmentation

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Capsular contracture is a possible complication following insertion of breast implant, and since you have already had this occur you are at increased of subsequent recurrence. Although revisions of breast lifts and augmentation also incur risks, you may wish to undergo a procedure that would minimize your risk of developing capsular contracture - including placement of the implants in a submuscular location.

Olivia Hutchinson, MD
New York Plastic Surgeon

Revision of Cosmetic Breast Surgery

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Interesting.   Every surgeon has his/her way of dealing with the financial responsibilities of revision surgery. Concerning the capsular contracture i would remove the capsule, place the implants beneath the muscle and make any necessary adjustments to the skin/incisions.  I believe in implant displacement exercises which help keep the pocket open and soft.

Dr. ES

Scared of capsular contracture

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Correction of capsular contracture is a difficult problem. Once you have developed a contracture, you are at an increased risk of developing a recurrence. Prevention of the contracture should be the primary focus of the revision. In order to decrease the risk, I would advise my patients of the following interventions:

  • The first is a site change of the implants to a dual-plane. This means placing the implants partially under the muscle (the top 2/3). Submuscular placement does have a lower risk of contracture
  • Use of a dermal matrix such as Alloderm and Strattice. These are biologic tissue "slings" which are place along the breast fold to support the implant from below and are attached to the muscle. These biologic slings have shown to have a significant decrease in capsular contracture rates. In several recent studies, the inflammatory response in the area of the dermal matrix is essentially non-existant and the result is the near-absence of an actual implant capsule. This is a very exciting area of research and may become standard for recalcitrant capsular contracture cases.
  • Simplify the procedure - If a portion of the procedure can be done at a later time, delay it. Minimizing the "adjustments" to the breast and simplifying the revision allow for more predictable results.
  • If the proposed revision surgery does not make sense, get a second opinion.

Revision operations are difficult and often less predictable than the original surgery. Also, they are usually costlier. Be upfront about what costs would be incurred if you develop another contracture. In addition, I would not advise the "manual release" of a contracture. This is known as a closed capsulotomy and is not recommended as it is unproven to correct a contracture and may lead to implant damage or rupture.

David Bogue, MD
Boca Raton Plastic Surgeon
5.0 out of 5 stars 26 reviews

Breast Revisionary Surgery

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I would definitely recommend switch to a submuscular pocket to decrease risks for recurrent contracture. It is money well spent, to decrease your risks for recurrence. If you end up with a 3rd surgery, there will be more financial obligation in the long run. Save up and do the right procedure as recommended by your physician.

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.