I'm getting a revision done soon due to CC on right breast. Should I get smooth implants again or textured this time? (Photo)
Doctor Answers 5
Replace implant for capsular contracture
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.
Management of Unilateral Capsule Contracture
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.
Tom DeWire, MD, FACS
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Capsular contracture: treatment choices
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.
Is this something I should be questioning? Smooth or textured Breast Implants.
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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