Closed capsulotomy and Botox used to release implant 4 weeks post op? Is this safe/normal procedure? (photos)

My surgeon attempted a closed capsulotomy not only once but twice at my 4 week post op and also injected my left breast with 4 shots of Botox(both horrible and painful for me). No 'pop' occurred from closed cap.Botox did nothing, breast feels firm and sits high, and I feel surgical error in over dissecting right breast pocket is also part of problem.i am very asymmetric and so disappointed. 7weeks post op now and getting more uneven each day. Thoughts?

Doctor Answers 7

Closed capsulotomy can void your warranty

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and I never suggest that procedure... and you didn't hear a pop so it didn't work.  Botox?  It works on muscle so not sure why it was attempted.  You have asymmetry.  You should be doing everything you can to support your lower side and pushing down on the higher side if you have smooth round implants.  I use no wire sport bras or leisure bras and pull the band under the breast over the top on the higher one and push down as well.  If  you have textured anatomic implants, they are designed to be moved about with external massage so you would be looking at a revision.  Your surgeon knows you have a problem and should do everything possible to help you through this.

Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews

Capsular Contracture and Bottoming Out of breast implants

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Large breast implants are more likely than small ones to cause bottoming out which is what is starting to happen on the right. The main problem with closed capsulotomy is that even if the capsule can be disrupted (which you say you don't think happened anyway), the capsule is still there and the opened area is small. That allows the capsule to re-form relatively quickly in almost every case. There may be other reasons for your surgeon having done it, though. Botox is helpful for spasm which might have been done to reduce discomfort.

Implants that have issues like this can be repositioned with the use of biologic materials to support the implants to prevent recurrent bottoming out. They seem to have some use in reducing the incidence of a recurrent capsular contracture as well.

Malik Kutty, MD
Sugar Land Plastic Surgeon

Closed capsulotomy and botox

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Thank you for your question.  Closed capsulotomies are painful and essentially have been abandoned.  The use of Botox may relax your muscle, but it will not prevent capsular contracture.  

Brian C. Reuben, MD
Salt Lake City Plastic Surgeon
5.0 out of 5 stars 37 reviews

Does botox and closed capsulotomy help capsular contracture?

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Hi Peasfulmama,

Thank you for your question and your excellent photos. I certainly would not do Botox and a close capsulotomy to treat your capsular contracture. I certainly think it's time for another opinion. The textbook answer to correct to correct contractures is to do a total capsulectomy(scar tissue removal) and to place a new implant. Closed capsulotomy's have not been done for an extended period of time now due to the poor outcome and the unpredictability of their results. Botox only helps to relax the muscle, but will have no effect on capsular contracture since we know that Capsular contraction is a scar problem not a muscle problem. It does seem that your right breast pocket has-been over dissected or that your implants are larger than expected and the tissue has relaxed more than expected. Your treatment is certainly not recommend by the majority of plastic surgeons but it is something that most do on a daily basis. Discuss your concerns with your plastic surgeon but also get other opinions from board-certified plastic surgeons. Good luck.

All the best,

Carlos Mata MD, MBA, FACS

Board-certified plastic surgeon


Carlos Mata, MD, MBA, FACS
Scottsdale Plastic Surgeon
5.0 out of 5 stars 38 reviews

Closed capsulotomy and BOTOX for my breasts? Why?

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I would agree with the other comments in that closed capsulotomy is a procedure that is no longer recommended due to the risk for bleeding and implant injury.  As for BOTOX, I have actually used this on a number of my patients to relax the muscle.  However, if you are developing capsular contracture, I am not sure that BOTOX will have any effect.

I would also recommend a second opinion.

I hope that helps!

-Gregory A. Buford MD FACS

Closed capsulomy

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Thanks for your question. Although popular years ago, closed capsulotomies are not recommended, as the release is unpredictable, and bleeding can occur, not to mention implant rupture.  The best option is likely an open capsulotomy and implant exchange.  Similarly, Botox will not likely affect your result.  You may want to seek another opinion. Best Regards.

Closed capsulotmy

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Once popular, closed capsulotomies have been abandoned by most of the surgical community. You appear to be developing a capsular contracture and you may benefit from a second opinion by an experienced breast surgeon.Good luck!

Marcel Daniels, MD
Long Beach Plastic Surgeon

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.