Good Idea Not to Replace Breast Implants After Capsular Contracture?

Question

I have a stage 4 capsular contracture in my right breast. I had my surgery 6 years ago. I am considering not getting the breast implants replaced and have an augmentation done. Do you think not replacing the implants are a good idea? I am told by 3 different doctors that I have enough breast tissue to create a full breast.

Jed H. Horowitz, MD, FACS · Answer

#Capsular #Contracture is a condition in which the capsule around the implant thickens and squeezes the implant making it hard and often changing the shape and position of the implant. It is more common in nicotine users (e.g. smoking or nicotine patches or gum). Effective treatment of the capsule frequently involves completely removal of the capsule (capsulectomy), and occasional incisions in the capsule may be somewhat helpful (#capsulotomy). In the past, closed capsulotomy, in which the breast is squeezed until the #capsule breaks, was used. Currently, most doctors avoid this technique because of complications associated with the technique and because the implant companies will void their warranty if this technique is used. 
At times it is necessary to change the position of the implant, either above or below the muscle, depending upon the initial position, changing the #implants themselves and, on occasion, the use of Acellular Dermal Matrix (ADM) may be required to prevent continued problems. Although the published risk of capsular contracture is approximately 9-11%, in our practice it is somewhat lower after initial implant placement. Once capsular contracture occurs, the risk of problems with secondary surgery rises to between 25% and 40%. The use of #Singulair and Vitamin E may be of benefit. If you had a Sientra Textured Implant placed as a primary procedure and a contracture occurs in the first two years after primary augmentation, then their implant warranty may apply.
I suggest consulting with a board certified plastic surgeon to discuss your best #options based on your intention to either completely remove or exchange your current implants. Such will determine your surgical plan.  Plastic surgeons who have specialized in breast surgery and cosmetic surgery are suitable to perform your breast implant removal or revision. Aside from checking board-certification, 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.

Richard J. Bruneteau, MD · Answer

The treatment of capsular
contractures can be difficult and is often associated with significant
frustration.It’s important to realize
that a large variety of options are available to treat this condition. The exact choice will depend upon your
anatomic findings and aesthetic goals. For this reason, it’s important that you carefully consider all your
options.If you no longer want breast implants and can accept a
smaller breast size, it is not unreasonable to remove the implants and perform
a capsulectomy. It’s important to
understand that additional procedures may be necessary for aesthetic
reasons. For this reason, breast lift
surgery may be necessary to treat breast sag and create an aesthetically
attractive breast.In contrast, if you still want larger breasts, a
multitude of options are still available.These include placing the implants in the original breast pocket
following capsulectomy.It’s also
possible to create a new breast pocket in a new location.It’s important to understand that the
potential for recurrent capsular contracture is high whenever implants are
replaced following capsulectomy.For
this reason it’s important to consult a board certified plastic surgeon with
experience in this area.This surgeon
should be able to formulate a treatment plan that addresses your anatomic
findings and achieves your aesthetic goals.

Otto Joseph Placik, MD · Answer

I  would consider implant removal and replacement in a neopectoral pocket to reduce the potential for a recurrent capsular contracture.

Trevor M. Born, MD · Answer

Dear MiaHope, you have several options on your situation.
1) remove the implants only- wait and do a breast lift later
2) remove the implants and do an immediate breast lift
3) remove the implants, have and open capsulotomy and replace the implants
4) remove, open capsulotomy, replace the implants and immediate breast lift
If you have a breast lift- the breasts will appear smaller- even if no tissue is removed.
There is a medication called Singulair which is used for childhood asthma- as an off label prescription it can be helpful with Capsular contracture.
With Warm Regards, 
Trevor M Born MD

Bahram Ghaderi, MD · Answer

Capsular contracture can be difficult to treat. If you have enough breast tissue to be happy with your size after removal of your implants, then not replacing the implants is good idea as it will remove the possibility of having capsular contracture again. You will likely have a breast lift to improve your breast shape after implant removal. There is no harm in leaving the implant out and if you are unhappy with your breast size to revisit having an implant placed back in sometime in the future - 6mo or more once you have healed from your surgery. Discuss your options with your surgeon carefully and be sure to understand the trade-offs with the choice you make.

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Good Idea Not to Replace Breast Implants After Capsular Contracture?

Answers (8)

Answer: Breast Lifing, Augmentation, Recovery, capsular contracture

Answer: Breast Lifing, Augmentation, Recovery, capsular contracture

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