If Capsular Contracture Comes Back, is It Usually Worse, Same or Better Than Before?

Usually, when a patient develops a capsular contacture, it is a good idea to change SOMETHING when you take out the capsules to try and minimize the risk of a recurrence.  There is a higher incidence of capsular contractures when implants are placed above the chest muscle than below it.  I believe this is due to better blood supply, less exposure to possible contaminants, and the massaging action of the muscle.  I don't have any statistics but, based on my experience, I would say that there is a good chance that you will develop a capsular contracture again at some point.  My best advice would be vigorous massage and, if it looks like you are developing firmness again, warm compresses, Vitamin E or Accolate (whatever your doctor likes to use), and possibly a course of antibiotics if there is a suggestion of an infection as the cause.  If you DO develop a capsular contracture again, I would suggest submuscular placement of your implants the next time around.

It is impossible to say that anything is a100%. Saline or silicone implants placed in a subgladular position have a higher chance of getting a capsular contracture than implants placed in a submuscular position. Though, since you are a revision, you are at a higher risk of capsular contracture. In medical studies the incision has not been shown to affect capsular contractures statistics too much. I would say that you are at an increased chance of developing capsular contracture based on your history of having developing capsular contractures. If you need a further revision I would suggest using silicone implants in a submusclar position.

CC recurs regularly enough that we, as plastic surgeons, tell patients that it is probably at least a 50/50 chance, at least I do.  There is just no way to predict.  I personally feel that subglandular implants have a higher chance of CC, and of recurrence, ESPECIALLY if the capsule is not completely removed. I use mostly implants with "smooth" shells (rather than "textured") so I advocate that patients "massage" the implants (move them) starting 1 week after surgery.  Seems to keep CC rates very low in my practice.

While the exact cause of CC is unknown many Plastic Surgeons believe it is due to low grade infection.  Modern techniques try to minimize any contact between the implant and the skin. Often after capsulotomy and replacement of the implants the contracture doesn't come back. Many times the implant pocket is changed from on top of the muscle to below. Ruptured silicone implant have been associated with contracture. Singulair may help reduce contracture. 

The rate of recurrence varies some say as high as 50%.  It is recomended to remove all the capsule if possible and depending upon the pocket location to perhap change it.  Some will use Strattice as well and of course change the implant.  Difficult to say if it is worse during recurrence.