I've Had 2 Breast Augs & May Need a 3rd Due to Encapsulation. Should I Have a 3rd? Should I Change the Type/size?

Hello,

I am sorry you are having these recurring problems with your breast augmentation.  Although not completely understood, capsular contracture is a process associated with inflammation, usually caused by bacterial contamination of the implant.  There is also a genetic predisposition as well that might make you more prone to it.  (note: if it were all due to genetics, then both breast implants would be contracted.) 

There are some myths that are not substantiated by science or my experience with the complication, one specifically is that heavy exercise will cause the problem to happen or recur. Many of my patients are body builders, fitness models, gym rats, and yogis doing strong inversions on their hands day in and day out, but none of them have a higher rates of capsular contracture.  Most of my colleagues will concur with that as well.  It is true that excessively large implants put you at higher risk for initial capsular contracture, but not recurrent cc.

The optimal treatment of capsular contracture is total capsulectomy (complete removal of all scar tissue around the implant), placement of a drain, and replacement of a new implant via a 'no touch' technique like the Keller Funnel.  There is a growing body of evidence that products like Strattice or Alloderm (acellular dermal matrix) might decrease recurrence as well. In my practice, my patients take Singulair for one to three months post capsulectomy.  I do not regularly use Strattice, except upon request by the patient.

Unlike primary breast augmentation, total capsulectomy is a challenging, sometimes exceedingly difficult surgery to perform optimally.  Frequently, excessive bleeding due to inadvertent injury to the surrounding tissue puts the patient at higher risk for cc again. Therefore, some surgeons choose to do limited capsulectomies.  Unfortunately, these surgeries lead to higher risk of cc!

Discuss with your doctor what he did for you and explore your options for any future intervention. This conversation would include type of surgery performed, the use of drains, the use of drugs like Singulair, and the use of ADMs like Strattice.

Best of luck!

Thank you for your question. There's a saying in plastic surgery that one must have a plan A and a plan B, but B should not be like A. So, doing plan A for the third time, what will prevent it from failing and being a success? That's what I thought too. Obviously without photos and the benefit of an in person examination, I can give you only general guidelines. I would suggest using Strattice, a tissue matrix, and also a site change (a new pocket) and gel implants. Talk to your surgeon or seek a second opinion from a board certified plastic surgeon. Good luck.

Not sure where your pocket is made but releasing the muscle and using stratus is a good option to try to control capsular contracture.  Popping the encapsulation is not a good choice and is painful.

When you have had a recurrence of capsular contracture you need a new plan. The one thing that is most effective at reducing the risk of recurrence is to use a Strattice graft after removing the scar capsule (capsulectomy) and replacing the implant.

You have to figure out what has been done to prevent contractures in your subsequent procedure and if new implant/new pocket was not done, that is one thing you could consider.  If you continue to have contractures, I personally would not encourage you to keep 'trying' due to the high risks for disappointment and continued costs.  As for external compression in attempts to tear the capsule, it will void your warranty and can be quite uncomfortable and has the risk for bleeding.  Just don't keep repeating the same procedure as those are doomed to failure.

I would definitely NOT let your Dr do a closed manipulation to "pop" the breast capsule. This would be a temporary fix and risk rupturing your implant not to mention very painful for you. If your left breast is unacceptably firm and misshapen compared to the right and it truly bothers you, you will want and need another surgery to remove the ENTIRE capsule and replace with a NEW implant most likely in a different pocket than previously. You may also need to have a sheet of artificial skin, Alloderm or Strattice to "cushion" your implant so as decrease the risk of re-encapsulating. 

This is for general educational information only and should not be construed as specific medical advice.  If you would like to establish a doctor-patient relationship, we would be delighted to set up an appointment to see you. If it is more convenient to be seen closer to your home, then you should follow-up with local doctor in your locale.