Can I Beat CC with Newer Treatment Options?

Original BA Aug'10, redo of left side 3 weeks later due to seroma & included drain. The left breast is smaller and aches, I know I have CC. After months of promises of a redo, PS states "no solution" saying it will get worse. Now I'm left searching for a specialist in revisions. My question is, am I a lost cause or is there hope? What new treatment options are available for CC and where can I find a trustworthy PS who wont lead me on only to let me down?! I'm ready to give up padded bras forever

Doctor Answers 14

Newer Treatment Options for Recurrent Scarring around Breast Implants

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Truly sorry for what you are going through. The problem with enthusiastic "Newer Treatment Options" is that for the most part they are only hype and will let you down. I believe patient should NOT be patronized and sold a bill of goods the way they often are at the cosmetics counter where dreams are sold but never delivered. Instead, you should be educayted by your surgeon as to the process, to the available options and be told the likelihood of success BEFORE embarking on one of them.

Increasingly, it appears that scarring around implants (Capsular Contracture) is caused by microscopic bacterial colonization creating a BIOFILM on the surface of the implant. The biofilm behaves in different ways and sttimulates different reactions in different people but it is nearly impossible to eradicate without removal of the implant and all traces of the process. As a result, trials of
- external ultrasound to heat the scar - failed
- attempting to squeeze the breast until the implant literally breaks through (sometimes getting stuck in the hole with a dumbell deformity), the Closed Capsulotomy - is painful, may burst an older implant  and frequently is associated with recurrence of a tighter scarring
- Use of Anti-Asthmas drugs (Accolate) to soften the scar are based on a few 10 year old non-scientific studies which were not reproduced by other surgeons. Since there have been deaths associated with Accolate use and this use is not FDA approved, surgeons may be reluctant to try it these days.
- use of Papaverine / Vit. E  to soften the scar is not helpful in all cases but does not carry major risks. 

Hope this helps.

Peter A Aldea, MD

Memphis Plastic Surgeon

Non-surgical treatment of capsular contracture only works early

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Non-surgical treatment of capsular contracture only works early on in the process. Accolate will halt and sometimes reverse the process. However, it rarely works effectively this late after surgery. This type of capsular contracture will likely require removal of the breast capsule (capsulectomy). Placement of Alloderm may help it from recurring again.

Kevin Brenner, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 23 reviews

Solution for capsular contracture after breast augmentation surgery

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Hi, I'm sorry you are going through this. Unfortunately, CC is a complication associated with implants placed above the muscle. The risk is much lower under the muscle, but can still occur. The best thing to do is to remove the implant and the capsule. Since you had a drain in the past, I would make sure there is no infection present before considering placement of new implant. If original implant was under the muscle (and there is no infection), then you would have to wait a few months for tissues to heal. If original implant was over the muscle (and there is no signs of infection), then placement of new implant would go under the muscle. Same would be done for the right side to achieve symmetry. So in essence a virginal pocket must be present to achieve success. I hope this helps you. Best wishes, Dr. H 

Gary M. Horndeski, MD
Texas Plastic Surgeon
4.5 out of 5 stars 229 reviews

Newest treatment for capsular contracture after breast augmentation

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Capsular contracture can in some cases respond to oral medication such as Singular or Accolate.  These are designed to inhibit smooth muscle contraction and are otherwise used for treating asthma.  Surgical release also works well but here is alway a chance for recurrence.  Biologic membranes such as Strattice or Veritas can be surgically placed around the implant and this seems to inhibit capsular contraction very well.

Find a Board Certified Plastic Surgeon who has a lot of experience with revision surgery to help you make a good choice. Be sure you can see a lot of pictures of similar procedures performed by the surgeon.

Strattice or Alloderm for capsular contracture

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Acellular dermal matrix materials such as Strattice or Alloderm have been very effective in my experience in preventing recurrence of capsular contracture. The usual approach is to remove the scar capsule (capsulectomy) and replace the implant. Because the capsulectomy may leave the tissue thin, the Strattice also serves to replace the tissue and add support to the pocket.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 56 reviews

Treatment of unilateral capsular contracture

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The presence of capsular contracture in the one breast that required revision shortly after your original procedure suggests that the process is most likely related to your original surger(ies).  There are several good treatment options available, depending upon a more detailed history and physical exam.  With proper care you should have a good chance for success following a revision, and nothing you have stated suggests that you are a "lost cause".  I would recommend consulting a board-certified plastic surgeon who is experienced and has been successful in treating capsular contractures.

Good luck.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship.  You need to consult with (i.e. personally see) a board-certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

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

CC in breast

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More details and of course an exam would be essential to outline a plan.  But having a CC means that you may be at risk to develop it again.  If it is the first time for a patient,. I usually consider an implant exchange and removal of the capsule( as best as possible), and sometimes a pocket change.  Other options include also using Strattice, but that can be rather expensive and I would consider that in a repeat event.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Fat grafting may be an option

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Without all the details about your procedure; sub glandular or sub muscular, the thickness of your tissues, the degree of capsular contracture etc., it's not possible to make definitive recommendations. You may be a candidate for a straightforward capsulectomy and implant exchange. Though there is a higher risk of recurrence,  it's usually worth keeping it simple initially in my opinion. Alloderm etc add significant expense to these procedures.

If you have mild capsular contracture, simple fat injection (removed with liposuction) can be considered, to correct the volume issue, and soften the capsular contracture. 

Finally, particularly if the capsular contracture recurs, fat grafting for complete breast augmentation can be considered. Unfortunately the only way that the risk of capsular contracture can be eliminated, is if there are no implants.

Treatment Of Capsular Contracture

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Capsular contracture does have a high recurrence rate.  Since your contracture is unilateral, it may be related to the seroma.  You didn't mention the location of your original of your original implant placement, but they should be moved under the muscle if initially placed above it.  I agree with Dr. Beraka that AlloDerm would be beneficial as well.

John Whitt, MD (retired)
Louisville Plastic Surgeon

Alloderm can help prevent capsular contracture.

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I recommend finding a plastic surgeon who uses Alloderm tissue matrix in revision breast augmentation.   It is quite effective.

George J. Beraka, MD (retired)
Manhattan 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.