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

Question

I have grade 3 capsular contractor in my right breast, I have textured under the muscle , this developed after 2 and half years of having the implants , my surgeon has said he would like to fix the problem but said its up to me if I have them under the muscle or over , I am unsure what to do. i need to make the right decision! I do believe that my right breast became contracted because I use my right arm with everything I do, picking up children, etc, I am very slim

D`Arcy Honeycutt, MD · Answer

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.

Richard Baxter, MD · Answer

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.

Vincent N. Zubowicz, MD · Answer

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.

Kenneth Hughes, MD · Answer

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.

Dennis Dass, MD · Answer

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.

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

Answers (5)