I'm getting a revision done soon due to CC on right breast. Should I get smooth implants again or textured this time? (Photo)

I had my BA in February 2014 I had 375cc smooth round mod plus implants under the muscle. Saw my surgeon as I had noticed changes on my right. and he said I have CC and need a revision. He suggested only touching the affected breast and reusing the same implant. Does this sound normal? And he said there was need need to change from smooth to textured implants. I thought I would have to have both implants replaced after a capsulectomy on my right breast. Is this something I should be questioning?

Doctor Answers 6

Replace implant for capsular contracture

Most evidence shows that capsular contracture is related to something called biofilm, and it cannot be removed so replacing the implant is a routine part of the treatment in addition to removal of the scar capsule (capsulectomy). There is no evidence that massage or other exercises have any effect on CC. Since it only involves one side, you should replace with the same type of implant so both breasts will feel the same. 

Replace implant for capsular contracture

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Most evidence shows that capsular contracture is related to something called biofilm, and it cannot be removed so replacing the implant is a routine part of the treatment in addition to removal of the scar capsule (capsulectomy). There is no evidence that massage or other exercises have any effect on CC. Since it only involves one side, you should replace with the same type of implant so both breasts will feel the same. 

Type of Breast Implant with Revision

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. Each implant have their benefits. 

#SalineImplants is made with a #silicone outer shell that is filled with saline water during the surgery. It is filled with sterile saline (salt-water). Since saline is like normal body fluid, it is safe and easily absorbed if the implants were to leakThe #implant shell is ordered in a specified size which can be filled to a minimum or maximum fill amount. This allows the plastic surgeon some flexibility with sizing during surgery. Often times a woman has breasts which vary slightly in size. If one breast is slightly smaller than the other, each implant can be filled to a different amount to create better symmetry. Saline tends to be a little less natural feeling than silicone, but it can also create a more dramatic upper breast appearance, which some women prefer. A new saline breast implants option called Ideal Implant™ was recently FDA approved and was created for women who are not comfortable having silicone implants in their body, but desire a more natural feeling implant than traditional saline implants on the market. The unique structure of the Ideal Implant allows for a similar look and feel as silicone with the safety of saline. 

#SiliconeImplants are made with a silicone outer shell and are filled with a gummy-bear consistency silicone on the inside. More women tend to choose silicone breast implants due to the natural feel and appearance. Silicone implants are now made of a cohesive gel which are anti-leak even when cut. Look and feel like natural breasts due to the cohesive silicone gel material. New generation silicone gel implants are far superior than those used in the past and have a proven track record of safety. Silicone implants have gone through more testing than any other medical device and are the preferred choice for over the muscle implant placement. 
To further ensure the safety, the FDA recommends women have periodic MRI testing to ensure their silicone implants are free from any defects.


#Shaped implants are all #textured and should not rotate when used properly. In my practice, about 20% of the patients benefit from shaped implants. Your Plastic Surgeon needs to measure you and determine the best shape and size of any implants that are used.Any cosmetic #revision has risks of unhappy outcome or other complications. Also, the right implant for the revision is contingent 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.

Type of Breast Implant with Revision

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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. Each implant have their benefits. 

#SalineImplants is made with a #silicone outer shell that is filled with saline water during the surgery. It is filled with sterile saline (salt-water). Since saline is like normal body fluid, it is safe and easily absorbed if the implants were to leakThe #implant shell is ordered in a specified size which can be filled to a minimum or maximum fill amount. This allows the plastic surgeon some flexibility with sizing during surgery. Often times a woman has breasts which vary slightly in size. If one breast is slightly smaller than the other, each implant can be filled to a different amount to create better symmetry. Saline tends to be a little less natural feeling than silicone, but it can also create a more dramatic upper breast appearance, which some women prefer. A new saline breast implants option called Ideal Implant™ was recently FDA approved and was created for women who are not comfortable having silicone implants in their body, but desire a more natural feeling implant than traditional saline implants on the market. The unique structure of the Ideal Implant allows for a similar look and feel as silicone with the safety of saline. 

#SiliconeImplants are made with a silicone outer shell and are filled with a gummy-bear consistency silicone on the inside. More women tend to choose silicone breast implants due to the natural feel and appearance. Silicone implants are now made of a cohesive gel which are anti-leak even when cut. Look and feel like natural breasts due to the cohesive silicone gel material. New generation silicone gel implants are far superior than those used in the past and have a proven track record of safety. Silicone implants have gone through more testing than any other medical device and are the preferred choice for over the muscle implant placement. 
To further ensure the safety, the FDA recommends women have periodic MRI testing to ensure their silicone implants are free from any defects.


#Shaped implants are all #textured and should not rotate when used properly. In my practice, about 20% of the patients benefit from shaped implants. Your Plastic Surgeon needs to measure you and determine the best shape and size of any implants that are used.Any cosmetic #revision has risks of unhappy outcome or other complications. Also, the right implant for the revision is contingent 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.

CC

 I agree with your surgeon about only operating on the affected breast unless you want to change implant size. Some surgeons would use the same implant and others a new implant. Alot also depends on technique such as antibiotic use, irrigation, etc. It would be best to check with your surgeon.

Barry M. Schwartz, MD
Weston Plastic Surgeon
4.0 out of 5 stars 4 reviews

CC

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 I agree with your surgeon about only operating on the affected breast unless you want to change implant size. Some surgeons would use the same implant and others a new implant. Alot also depends on technique such as antibiotic use, irrigation, etc. It would be best to check with your surgeon.

Barry M. Schwartz, MD
Weston Plastic Surgeon

Management of Unilateral Capsule Contracture

Beathy77,

Capsule contracture is a normal, but undesirable physiologic response to inflammation encountered at the time of surgery, in most instances, or occasionally long after the procedure.  Generally the offending agents, are low level germ contamination, or bleeding around the implant that leads to inflammation, or exposure to skin cells and debris that are rubbed off the wound edges, the latter occurring mainly with pre-filled silicone implants.  Also, routes that traverse cut breast ducts (areola incision approach) has a higher potential contamination risk as the implant is passed through the divided breast tissues, and open cut breast ducts that may contain germs.  Because the offending contaminant is thought to be attached to the implant shell, using the same implant again may lead to recurrence of the process, as the offending contaminant is still on the implant as a complex biofilm that cannot be removed. Also, the manufacturers recommend against that practice.  Early treatment of the process with Accolate or Singulair can often head off or reverse this tight scarring and eliminate the need for any intervention, but it needs to be used early in the process, and requires 3-6 months of treatment, or more.  Additionally, those meds are not as effective at getting the implant to drop into position, even if the scarring can be softened gradually.  You should inquire to your surgeon whether he uses that medication, as it is pretty widely used in the US for off-label treatment of capsule contracture, and is usually given for a period after augmentation revision with implant replacement and complete removal of capsule scarring in the instance of unresponsive capsule contracture.  About the only situation where it may be reasonable to leave the implant in place is when Accolate or Singulair lead to complete softening of the scar, but not to settling into proper position.  In that instance I find it appropriate to just lower the position of the pocket by internal scar release, letting the implant drop into place with otherwise soft capsule scar surrounding it.  Myself, and many other surgeons, do not believe that textured silicone implants prevent capsule contracture, though there are some advocates.  Further, textured implants are much firmer than smooth shell silicone, and they have a greater tendency to show visible rippling.  It may be reasonable to seek other opinions before you proceed with the plan as outlined.  I hope that this helps. A link below discusses cause and management of capsule contracture, along with photo examples.  I hope that this helps. 

Best wishes,     

Tom DeWire, MD, FACS    

Thomas M. DeWire Sr., MD (retired)
Richmond Plastic Surgeon
4.3 out of 5 stars 35 reviews

Management of Unilateral Capsule Contracture

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Beathy77,

Capsule contracture is a normal, but undesirable physiologic response to inflammation encountered at the time of surgery, in most instances, or occasionally long after the procedure.  Generally the offending agents, are low level germ contamination, or bleeding around the implant that leads to inflammation, or exposure to skin cells and debris that are rubbed off the wound edges, the latter occurring mainly with pre-filled silicone implants.  Also, routes that traverse cut breast ducts (areola incision approach) has a higher potential contamination risk as the implant is passed through the divided breast tissues, and open cut breast ducts that may contain germs.  Because the offending contaminant is thought to be attached to the implant shell, using the same implant again may lead to recurrence of the process, as the offending contaminant is still on the implant as a complex biofilm that cannot be removed. Also, the manufacturers recommend against that practice.  Early treatment of the process with Accolate or Singulair can often head off or reverse this tight scarring and eliminate the need for any intervention, but it needs to be used early in the process, and requires 3-6 months of treatment, or more.  Additionally, those meds are not as effective at getting the implant to drop into position, even if the scarring can be softened gradually.  You should inquire to your surgeon whether he uses that medication, as it is pretty widely used in the US for off-label treatment of capsule contracture, and is usually given for a period after augmentation revision with implant replacement and complete removal of capsule scarring in the instance of unresponsive capsule contracture.  About the only situation where it may be reasonable to leave the implant in place is when Accolate or Singulair lead to complete softening of the scar, but not to settling into proper position.  In that instance I find it appropriate to just lower the position of the pocket by internal scar release, letting the implant drop into place with otherwise soft capsule scar surrounding it.  Myself, and many other surgeons, do not believe that textured silicone implants prevent capsule contracture, though there are some advocates.  Further, textured implants are much firmer than smooth shell silicone, and they have a greater tendency to show visible rippling.  It may be reasonable to seek other opinions before you proceed with the plan as outlined.  I hope that this helps. A link below discusses cause and management of capsule contracture, along with photo examples.  I hope that this helps. 

Best wishes,     

Tom DeWire, MD, FACS    

Thomas M. DeWire Sr., MD (retired)
Richmond Plastic Surgeon

Capsular contracture: treatment choices

Thank you for your question.
Firstly your left breast seems like a great result and therefore if the size is good, no operation is required on this side.
Bacteria from the skin or breast gland on the implant at the time of insertion is commonly associated with capsular contracture when there is no problem with the implant (eg rupture). When established and it has occurred only on 1 occasion, the mainstay of treatment is the removal of all of the existing capsule and the use of a number of measures to reduce bacterial hitching a ride on the implant.
There is much debate about implant choice, there are different published rates for smooth and textured implants. You could get a good result with either, published literature would suggest this is less likely with textured (slight difference) so the best choice is likely to be the one your surgeon if most comfortable with.
I hope this has helped.
Good luck

Mark Magnusson, FRACS (Plast)
Brisbane Plastic Surgeon
5.0 out of 5 stars 4 reviews

Capsular contracture: treatment choices

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Thank you for your question.
Firstly your left breast seems like a great result and therefore if the size is good, no operation is required on this side.
Bacteria from the skin or breast gland on the implant at the time of insertion is commonly associated with capsular contracture when there is no problem with the implant (eg rupture). When established and it has occurred only on 1 occasion, the mainstay of treatment is the removal of all of the existing capsule and the use of a number of measures to reduce bacterial hitching a ride on the implant.
There is much debate about implant choice, there are different published rates for smooth and textured implants. You could get a good result with either, published literature would suggest this is less likely with textured (slight difference) so the best choice is likely to be the one your surgeon if most comfortable with.
I hope this has helped.
Good luck

Mark Magnusson, FRACS (Plast)
Brisbane Plastic Surgeon

Is this something I should be questioning? Smooth or textured Breast Implants.

Thanks for the question.The implant showing CC should ideally be replaced with textured one,since the cause could be lying with the use of smooth implants or may be you did not do exercises and  massage of the breast in time or not enough.Normally after 4 week we advise to massage in a circular manner clock wise and anti clock wise for 20 minutes 3 time daily for 3 months.
I do not know what was your protocol.
What ever implant is used you can do it this time once all wounds have healed give 3 weeks for the massage to start.Let your partner help you with this.
Wishiing you all the best

Is this something I should be questioning? Smooth or textured Breast Implants.

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Thanks for the question.The implant showing CC should ideally be replaced with textured one,since the cause could be lying with the use of smooth implants or may be you did not do exercises and  massage of the breast in time or not enough.Normally after 4 week we advise to massage in a circular manner clock wise and anti clock wise for 20 minutes 3 time daily for 3 months.
I do not know what was your protocol.
What ever implant is used you can do it this time once all wounds have healed give 3 weeks for the massage to start.Let your partner help you with this.
Wishiing you all the best

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