Should I go under/over muscle for capsular contracture revision?

The risk of capsular contracture is higher when the implants are on top of the muscle.  I would recommend capsulectomy and placement of submuscular implants.  Make sure you massage the implants regularly to reduce the risk of recurrence.

Capsular contracture is the most common post-implant problem.  You are not alone.  We haven't figured a way to prevent all cases.  You have several options for treatment.  I would recommend removing the implant and using a new one.  The capsule can be removed completelyl or a neopocket created.  I have have good success with Strattice, an acellular dermis, sewn in the lower pocket.  A drain is often placed for a week or so.  Good luck.

In my experience the most effective way to prevent recurrence of capsular contracture is to do a capsulectomy (removal of the scar capsule) and place a Strattice graft. If you go above the muscle then you would need to do both sides or the breasts may look different. One way to do a "plane change" but keep the implant under the muscle is a procedure called "neosubpectoral." If it doesn't work however ou would be looking at yet another surgery.