Grade 4 capsular contracture. What is the best surgery to have if I were to have another one?

Question

I have been diagnosed with a grade 4 capsular contracture from my pa, I understand that there is a chance of a capsule returning with more surgery. What is the best surgery to have if I were to have another one...

Jeffrey M. Darrow, MD · Answer

The best evident to date implicates bacterial biofilms as the cause of capsular contracture.  Biofilms are difficult to eliminate, hence the reason that there is a high rate of recurrence if there is only a capsulotomy and implant exchange done.  The best chance for eliminating the capsular contracture and not getting it back, is to do a total removal of the capsule, let the area completely heal for 6-8 months and then reinsert new implants in a below the muscle position.  Removing the capsule gets rid of the majority of the biofilm.  Letting the area heal 6-8 months allows your body to clean up the rest of the contamination so when a new implant gets placed it is as close to a fresh operative site as possible.  Other options do not allow full clearance of the biofilm and risk recurrence of the initial problem.

William Andrade, MD · Answer

Hello, different surgeons will have variations in the way they manage capsular contracture.  If the implant capsule layer is fairly thin the treatment might simply involve opening the capsule around the entire perimeter to make more space for the implant (capsulotomy).  On the other hand, if the layer is very thick and inelastic, or if there is a layer of calcium around the implant like an eggshell, it might be necessary to remove the entire capsule (capsulectomy).   Your surgeon will be able to discuss their treatment plan and its rationale.

Jaime S. Schwartz, MD, FACS · Answer

I appreciate your question.

Removal and replacement of your implants with capsulectomy and depending on the amount of breast tissue you have, possible use of acellular dermal matrix .  Physical exam is needed to discuss all.

The best way to assess and give
true advice would be an in-person exam.

Please see a board-certified
plastic surgeon that specializes in aesthetic and restorative breast surgery.

Best of luck!

Dr. Schwartz

Don W. Griffin, MD · Answer

You are correct that the number one risk with surgery to correct capsular contracture is recurrence. CC recurrence can be minimized by using several surgical techniques including replacing the implant in a new pocket, changing implants, and using appropriate antibiotic/dilute betadine irrigation solution during the procedure along with postoperative massage techniques. If your implants are subglandular, they can be changed to subpectoral. If they are subpectoral, a new subpectoral pocket can be created.

Steven Wallach, MD · Answer

There is not one best way to treat this. In general, most would try to remove the capsule as best as possible, possibly place it in a new pocket under the muscle and/or maybe add an ADM with new implants.Some surgeons might remove the implants and have you wait several months before putting new ones in.

Daniel Del Vecchio, MD · Answer

SIEF is an operation where implants are removed and fat is used to give the breasts volume and shape.  It is a new procedure that was developed several years ago and many surgeons are now performing it. I I have attached a link to the original paper on the topic for your review.  You may want to consider this technique to rid yourself of implants.best wishesdr DelVecchio

Grade 4 capsular contracture. What is the best surgery to have if I were to have another one?

Answers (6)

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