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

Question

Hi, if CC returns after revision how bad is it likely to be? Sadly, I went subglandular again with an areola incision (I wasn't advised there were other options). I don't think the entire capsule was taken out or another pocket made, but new bigger implants were used. With that history, is it 100% guaranteed that I'll develop CC again and, if so, to what degree (worse, same or better than before)? Thank you.

Edwin C. Pound, III, MD · Answer

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.

J. Timothy Katzen, MD, FACS · Answer

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.

James E. Chappell, MD · Answer

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.

Ralph M. Rosato, MD · Answer

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.

Steven Wallach, MD · Answer

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.

Jourdan Gottlieb, MD · Answer

I wouldn't say the chances are 100%, but probably closer to 50%. And I don't think there is any data  to suggest that it might be better or worse than before. Your surgeon can tell you what particular technique was used.

	Post op massage and vitamin E will help decrease the chances of recurrence. Early treatment of recurrence with Singulair should be considered. Stay in touch with your surgeon. 

	All the best.

Karol A. Gutowski, MD, FACS · Answer

It seems that capsular contracture may return after surgery but there is no way to predict how severe it will be. 

	Be sure to check your breasts frequently and keep in touch with your surgeon If the capsular contracture does return, your surgeon should consider:

	
		Early use of ultrasound treatments and Singular (a medication) to stop the process
	
		If repeat surgery is needed, it is better to remove as much of the capsule as safely possible, not just release it
	
		Textured implants should be considered
	
		Under the muscle placement through the breast crease incision should be used
	
		Antibiotic washing of the new breast implants and implant space may be useful
	
		The use of an acellular dermal matrix product may help decrease the risk of recurrance but it is expensive and not well supported by studies


	Good Luck!

Terry A. Cromwell, MD (retired) · Answer

In my experience with scar tissue around the implant, after capsulotomy, the recurrence rate is around 59%. I try to change the pocket-subglanular to submuscular and if saline implants start massaging daily. If they are silicone gels under the muscle, do a partial capsulectomy and use a dermal subsitute, possibly a new implant,. Stratice right now is the dermal substitue I most commonly use. Even then the recurrence rate is around 5% You hope to obtain a well shaped comfortable breast with revision surgery.

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

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