Breast Implant Revision Required After Latent Capsular Contraction - Use Strattice or Move Under the Muscle? (photo)

I have 7 yr old Silimed silicone implants over the muscle. My left breast began slowly encapsulating 2+ years post-op. The contracture is not painful, but is not pleasing to look at or feel. I have had two pregnancies since the contracture started. Due to my shape & symmetry, my original surgeon placed implants over the muscle - I am thin, 5'6", 125lbs. I have had two consults on my revision: 1. Move to under the muscle, 2. Stay over the muscle & add Strattice. Which approach is better?

Doctor Answers 10

Breast Implant Revision for Subglandular Capsular Contracture

     With a subglandular capsular contracture, a switch to submuscular is probably prudent.  This also provides for camouflage for the implant.  The use of dermal matrices is very expensive and is not necessary in this case.  Find the board certified plastic surgeon with the best credentials.

Place implants under the muscle for a capsular contracture

This depends on you.  You appear to be very fit.  If you exercise a lot and need to have very strong pectoralis muscles, then it is better to have a capsulectomy, strattice, and keep the implants on top of the muscle.   If pectoralis muscle strength is not an issue, then place them under the muscle and save yourself some money.

Dennis Dass, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 102 reviews

Treatment of CC

Your CC is  almost certainly do to a low grade bacterial infection.  The best treatment is to remove the old scar capsule and make an new pocket under the muscle. This will decrease your risk of getting another CC as you are going into a new pocket in addition it will give you some upper pole muscle coverage which will benefit you as you get older.

Strattice is not necessary or a good idea in your case.

Robert Kearney, MD, FACS
La Jolla Plastic Surgeon
5.0 out of 5 stars 25 reviews

Treatment of CC


I agree with all, you should replace new implants into the partial subpectoral position (submuscular).  Your cc is not hard and painful, and it is not a recurrent issue.  ADMs like Strattice are expensive and usually used for recurrent cc.  You are experiencing a common phenomenon with subglandular placement of implants, and this is why a majority of surgeons put implants under the muscle on all of their patients.

Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 66 reviews

Implant pocket change

I usually place implants in a submuscular pocket.  Strattice can help with future capsular contractures but is expensive.

Steven Wallach, MD
New York Plastic Surgeon
4.0 out of 5 stars 23 reviews

What is the best revision approach for capsular contracture

In looking at your photos you are a thin woman with thin breast coverage. You will get different opinions depending on the plastic surgeon you see but my personal preference in your case would be to perform a removal and replacement with new implants, place the implants into a partially under the muscle position (called a site change). I think this serves 2 purposes; to provide a better upper inner breast coverage and it should also decrease the risk of a recurrent capsular contracture. I have included a link to a patient who underwent this procedure to give you an idea. I hope this helps.

Dr. Edwards

Use Strattice or Move Under the Muscle?

Either approach is sensible. 

My preference would be to move the implants under the muscle. The primary reason is that the on your photos the upper part of the implant is visible, and this would be improved by submuscular placement but probably not by using Strattice. The visibility of the implant is present on both sides, so it is probably not related to the contracture alone. 

Ask both surgeons about the pros and cons, and consider another opinion.

Thanks, best wishes.

Move Implants To Correct Capsular Contracture

I would definitely recommend moving your implants to a submuscular location.  Srattice may also decrease the chance for recurrence of the CC, but it is quite expensive and definely would add to your cost.

John Whitt, MD (retired)
Louisville Plastic Surgeon
5.0 out of 5 stars 2 reviews

Breast implant revisionp

I agree with the other good reviews that you have many options. I my hands I would do a site change to a partial sub muscular plane with new implants. The strattice is expensive but a reasonable option. You could also just have release of the scar tissue and implant exchange although this carries a higher rate of reforming of the capsular contraction. Use of Accolate 20mg twice a day after surgery is another option you can consider to reduce capsular contraction. Good Luck and please seek a board certified plastic surgeon.

Gregory T. Lynam, MD
Richmond Plastic Surgeon
5.0 out of 5 stars 46 reviews

Fat grafting can be helpful to soften the edges

You have minimal breast tissue to cover the implants and there are few options. The option of going under the muscle is a good . I offer combination of the pocket revision and fat grafting to give more soft tissue coverage.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.5 out of 5 stars 102 reviews

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.