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.