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

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.

One legitimate strategy for dealing with capsular contracture is to move the implant to a new location in the hope that a different environment will yield a better result. Going from behind the muscle to behind the breast or vice versa is worthy of consideration.

   For the first capsular contracture, a reasonable option is to perform anterior and posterior capsulectomies with implant exchange under the muscle.  Another reasonable option is not place a new implant in between the anterior capsule and the pectoralis.  These two approaches may be preferred in some patients if the patient has little breast tissue and the camouflage of the muscle enhances the cosmetic result.  Best of Luck.

It is usually better to place implants under the muscle to minimize the risk of a capsular contracture.

Use or non- use does not cause cc.  It is more likely linked to subclinical infection or contamination, or even things we don't know about.

Placing the implant under the muscle is the least likely position to yield a contracture plus other problems associated with implants above the muscle.

I agree.  You don't have to have the implant contracture fixed, unless it is symptomatic.  Alternatively, you must consider another option.  If you don't have implants, you don't get a contracture.  You may also elect to just have the implants removed and leave them out.

sek

As you can see from the answers there is no best way. Capsules can happen, they happen with smooth implants, textured ones, ones infront of the muscle and those behind. We wish there were a golden bullet but there is not. Good luck.

Because submuscular placement does provide some protection against contracture as compared with subglandular position, I would prefer an under the muscle option. These include either capsulectomy, or placement above the old capsule and above the muscle. I would add that there are advocates of site change to above the muscle, so there is no correct answer. I note all three possibilities have been suggested in the first three response.  Best wishes. 

I'm sorry to hear about the complication you have experienced. There is no evidence that suggests that the use of your right arm  would have increased your risk of breast implant encapsulation of the right breast. Based on your description, I think you will be best off undergoing capsulectomy and re-augmentation of the breasts in the sub muscular position. In my practice, I would probably also suggest postoperative breast implant displacement exercise/massage and the use of anti-inflammatory medication.

 Best wishes.

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.