What are the odds of capsular contracture recurrence?

Question

I started to develop capsular contracture on my left breast at 8 months post op. I'm 10 months post op and it is not getting any better. The shape has becoming like a ball. I am scared of having a surgery to fix it and getting capsular contracture again. My first question is: what is the percentage of capsular contracture recurrence? I have smooth silicone under, and I read that saline implants have a lower percentage of capsular contracture. Should I switch to saline or it does not matter?

Lewis Albert Andres, MD · Answer

Hello! Thank you for your question! Recurrent capsular contracture is a very difficult problem. Assuming you tried conservative measures in the past - implant massage and may add the medication Singulair and Vitamin E. If these fail, surgical correction may be necessary. It is a matter of surgeon preference as well as what is seen during your procedure that will determine whether or not a complete capsulectomy is performed. If significant capsule formation is seen intraoperatively, a full capule removal may be warranted with a drain in order to completely remove all of the tissue and allow better adherence of your breast back to its normal anatomic position down on your chest wall. Irrigating with certain medications may also be if benefit. Some other things that may have been tried include changing the position of your implant, addition of a dermal matrix, or consideration for the the shaped, textured, anatomical gel implants. Without knowing your issues and without an examination, it is difficult to tell you what may be the best thing for you. I tend to favor performing capsulectomies in order to create a fresh pocket, reshape the pocket, allow better shape and adherence of the overlying breast. I would discuss your issues with your plastic surgeon who will assist you in determining the right modality for you. At a 3rd recurrence, it may continue to occur despite all of these modalities and consideration for explantation or living with the contracture are options. Hope that this helps! Best wishes!

Ryan Neinstein, MD, FRCSC · Answer

Recurrence is high, with total capsule removal its about 20% and with just releasing the scar its probably 50/50

Kenneth Hughes, MD · Answer

A form stable implant may help reduce the rate, but saline vs conventional silicone does not make a difference. If this is the first capsular contracture, total capsulectomy with implant exchange is reasonable. In recurrent capsular contracture, dermal matrices may be incorporated into the surgery to decrease recurrence. Find a plastic surgeon with ELITE credentials who performs hundreds of breast augmentations and breast augmentation revisions each year. Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results. Kenneth Hughes, MD Los Angeles, CA

Vincent N. Zubowicz, MD · Answer

If you have a capsular contracture the incidence of that recurring is higher in the incidence for first-time breast augmentation patients. Saline implants do not have a lower capsular contracture rate than silicone gel.

Angela Champion, MD · Answer

Unfortunately, no one really knows who is going to develop a capsular contracture or why it happens to some people and not others. If it seems to be getting worse, it would be in your best interest to take care of it sooner than later. There is really no difference in re-occurance between saline or silicone implants, textured or smooth. It is true that if you have a CC, you run a higher risk of it occurring again. Oral medication (with risks of it's own), capsulectomy with same implant or new implant (my preference), or capsulectomy with same implant or new implant with a dermal matrix such as alloderm are all options. Talk with your surgeon so he can evaluate how bad your contracture is and see what options you have from there. ac

William B. Rosenblatt, MD · Answer

There are things we can do, but there is no guarantee it will not recur. Nothing is perfect - I don't believe that the implant makes a difference, some people get them and some don't. Why only one breast? Go see your doctor, some people believe in Vitiamins and some other medications, see what your doctor says.

Stephen Salerno, MBBS, FRACS · Answer

Hello

	It is true that you will more likely to develop capsular contraction on a second procedure.  How much higher, no one will really know.  Capsular contraction is multifactorial and there are many theories for its development.  If you have developing capsular contraction you would be best to get it seen to sooner rather than later as waiting will make things only worse.

	All the Best 

	Stephen Salerno

Robert L. Kraft, MD, FACS · Answer

Since the capsular contracture is worsening, the sooner you take care of it, the less likely you are to redevelop the capsule. Leaving it alone is an invitation to more extensive surgery. That said, it is true that, once you have developed a capsule, you are more likely than the general population to have a recurrence. If you are happy with the type of implants you have now, it is not necessary to switch.

Jourdan Gottlieb, MD · Answer

With recent generations of silicone implants there seems no longer an advantage to saline in terms of contracture. It may be that the new form stable implants do have an edge (Allergan #410), Using Strattice may also decrease the recurrence rate. All the best.

Terry A. Cromwell, MD (retired) · Answer

Your options are 1. do nothing and hope the contracture stabilizes, staying somewhat soft and the shape be acceptable-what is called a Baker gr2 capsule. 2. remove the implant and scar tissue,put the implant back. My experience with this approach has not been good, at least a 50% recurrence of capsule.3 Remove scar tissue and the implant, use a dermal substitute, I like Alloderm, put the implant back in. Its not perfect, but gives the best results for me.

What are the odds of capsular contracture recurrence?

Answers (11)

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