Over or Under if I Try It Again~ 3rd Time

In 2007 I had 300cc implants put under the muscle and 6 months later had them replaced in the same area and the same size due to Capsular Contracture. I then had those taken out in March 2010 because of Snoopy Breast and CC. I'm 42 5'5 and 128lbs and am very athletic and flat! When the implants were removed so was the extra skin and it isn't pretty.I would like to have small(200-250)put in but not sure.Do I go over or under the muscle? With my history should I even try to do it again?

Doctor Answers 6

Revision Breast Augmentation with History of Capsular Contracture

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I am sorry to hear about your past experiences.   First, I'd like to address why capsular contracture may occur.  There are several emerging theories explaining the possible etiology of scar tissue formation.  Some believe the presence of a subclicinical (low grade) infection creates a "biofilm" (a film that develops around your implant) that evolves into scar tissue (capsular contracture).  Others contend that the presence of small amounts of blood around your implant could stimulate this scar tissue.  And of course, there is a very very small minority of patients who are genetically prone to form scar tissue after breast implants.  Fortunately this percentage is very low.

Now what are your options?   First, I would need to evaluate the scars on your breast, the amount and quality of excess skin, your nipple position and of course your chest wall dimensions.  I would most likely recommend a dual-plane augmentation to achieve some degree of under the muscle coverage.  Making sure that your new implant pocket is very dry (ie almost zero blood loss) is important.  And given your history, perioperative antibiotic coverage should be considered (at least with the single preop dose of antibiotics).  Now keep in mind that no one who is telling you the truth can promise you that scar tissue may not return.  This simply can not be promised because the reality is - you could be one of those few unlucky patients who are genetically prone for capsular contracture.   One last option could be the use of a dermal matrix product (AlloDerm or Strattice) which has shown some early promise to slow down the process of scar tissue formation.

Please visit with a board certified plastic surgeon for a consultation.  Best of luck.

Dr. Basu

Houston, TX

Breast capsular contracture

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I am sorry to hear about your problems. As I understand it, you had capsular contracture after both of your previous breast augmentations. If the previous augmentations were in back of the muscle, then unfortunately you seem to just form capsules. A switch to saline implants might be helpful if you previously had silicone gel implants, but this is more hopeful than probable. If the previous augmentations were in front of the muscle, it would be worthwhile to place implants behind the muscle. Early in the history of breast augmentation, before we placed implants behind the muscle, we had some patients with capsular contracture that we could not improve no matter what we did. When implant placement behind the muscle became known, I transferred a number of these to the position under the muscle and the short and long term results were generally good. To be sure, you can get capsular contracture from implants underneath the muscle also, but the incidence is much less. The problem is more commonly due to patients not moving the implants around for 3 months or so after the surgery, so the implants become stuck in place. (If you did not move your shoulder for 3 months, it would become stiff, and that is a joint.) The other advantage of muscle cover is that there is additional padding in a person with a slim physique such as you have. The padding is particularly over the upper inner portion of the breast which is the part that shows with a low neckline, so you look more natural--particularly when wearing support that enhances your cleavage. In regards to size, the more there is of you and the less there is of implant, the more natural the result tends to be. Good luck.

Roger P. Friedenthal, MD
San Francisco Plastic Surgeon

Revision of breast augmentation

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I am sorry to hear about your previous bad experiences.  There are many potential causes of capsular contracture, some known and some unknown.  With a more detailed history and physical exam, it may be possible to narrow down what might have caused the problem and potential ways to decrease the chances for recurrence.  Based upon your height and weight, you will likely be better off with implant placement behind the muscle, and a "dual plane" augmentation should help to prevent a "Snoopy" breast appearance.  I would recommend a consultation with a Board-Certified Plastic Surgeon, who can obtain a complete history and physical exam, and advise you regarding your chances for success the third time around.

Best of luck.


Craig S. Rock, MD
Houston Plastic Surgeon
5.0 out of 5 stars 29 reviews


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It is impossible to tell you what to do without a more careful history and a complete physical exam. Some patients will have problems with capsular contracture whatever you do.  For others, there is a specific reason for it to occur. In general, the smaller you go, the less side effects and complications and with thin soft tissue and a history of CC you are probably better of going under the muscle statistically speaking.

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon

Breast Implant Position?

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Thank you for the question.


I am sorry to hear about your complicated course after breast augmentation surgery. Generally, if at all possible it is best (in my opinion) to replace implants under the pectoralis muscle (dual plane).  However, the major issue of concern is the overlying breast tissue and skin and whether further surgery will be necessary to achieve the aesthetic  results desired.  For example, some patients who have implants replaced into the sub pectoral space may benefit from breast lifting to achieve the desired goals.

In the event of capsular  contracture or severe breast implant rippling replacing implants in the sub muscle position is the best way to go in my opinion.  This may or may not be possible depending on your specific situation.

This type of surgery does require some level of experience. It would behoove you to seek consultation with well experienced board-certified plastic surgeons well-versed in revisionary breast surgery.

I hope this helps.

Over or under for augmentation

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Sorry to hear about your multiple surgeries. Based on your history, I would still place the implants under the muscle (dual plane), which usually lowers the capsular contraction rate. Sometimes, we never know the cause of the capsular contraction. Good luck.

Donna Rich, MD
Webster Plastic Surgeon
4.5 out of 5 stars 33 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.