Can you have capsular contracture more than once?

Question

I had breast augmentation 5 years ago, within 6 months developed capular contracture. My surgeon removed the implants and placed the on top of the muscle. Everything was great and breasts looked awesome until about 4 months ago. From the past experience the systems all the the same. Is this possible? Also, I have an auto immune disorder can this contribute to the problem?

Jeffrey J. Roth, MD, FACS · Answer

Thank you for your question.  The answer to your question is yes.  Indeed, patients with capsular contracture are more likely to get repeat capsular contracture.   As of this writing, the immune system has not been implicated in capsular contracture.  For capsular contracture there are non operative modalities, (taking singulair, message, Aspen treatment, short course steroids, etc).  We like singulair in our office, along with the other modalities.  One should take it for 90 days straight.  There are also operative modalities, (capsulectomy, capsulotomy, change of pocket, placement of ADM, removal).  If the non operative modalities fail, the breasts usually do not get softer with time.  They usually will harden, and become more odd shaped.  The definitive treatment at this writing is surgical.  Please speak with a Board Certified Plastic Surgeon about all your options.  The ASAPS and ASPS websites are good places to start.  You may be a better candidate for one over the other.
Jeffrey J. Roth, M.D., F.A.C.S.
Board Certified Plastic Surgeon
Las Vegas Plastic Surgery

Vincent N. Zubowicz, MD · Answer

Plastic surgeons do not know what causes capsular contracture but it certainly can recur after treatment. As far as we know any immune system disorder you have Plays no role.

Earl Stephenson, Jr., MD, DDS, MBA · Answer

Unfortunately, capsular contracture can occur more than once. Capsular contracture is due to a lingering infection coating the implant. Typically, the implant and the site of the implant is changed as well as the capsule removed. Earl Stephenson, Jr MD, DDS, FACS

Victor Ferrari, MD, FACS · Answer

Sorry to hear about your recurrent capsular contracture.  There are various things that can be done to try to prevent recurrence.  First, your surgeon should perform a complete removal of the scar tissue capsule and replace the implant with a new textured implant.  Be sure your surgeon chooses Sientra implants.  They are the only manufacturer that has a 2 year guarantee against capsular contracture due to the superiority of their texturization process.  Second, proper cultures should be obtained during surgery to be sure you don't have a chronic infection causing the recurrence.  Third, your surgeon my opt to place a drain at the time of surgery.  Fourth, see if your surgeon has any post-op treatments to help prevent recurrent capsular contracture.  We have a special laser protocol for our patients that has greatly reduced our CC recurrence rates.  Finally, be sure to take a dose of antibiotics before every dental procedure (even aggressive cleanings).  Though the studies are not definitive, some reports show that dental procedures have been linked to CC.

Edward S. Gronka, MD · Answer

Unfortunately the answer is yes. In fact, if you get one , you do have a higher chance of getting another one. Still worth treating though if it  is distorting the breast or causing pain.

Jeffrey Zwiren, MD · Answer

Capsular contractures are still unpredictable and poorly understood.   It certainly helps to place the implant behind the muscle and use the no touch technique as well as irrigating with a triple antibiotic solution.  Studies indicate that when the implant is placed above the muscle or subglandular position there is a higher risk.

Sanjeev Kaila, MD · Answer

Yes, capsular contracture can occur multiple times. Usually it can be corrected with capsulotomy alone but if it continues to keep reccuring then it is quite possible you have a low grade contamination if your implants in which the bacteria are protected by biofilm. In these situations the implants usually have to be replaced and a different pocket created for your new implants. It's best if you return to your former surgeon and ask him to evaluate it for you.

Steven Wallach, MD · Answer

The incidence of a recurrent capsular contracture is quite high maybe 50% or more. Ways to treat it include removal of the implants and placement of new ones, changing the pocket position sometimes, removing the capsule, adding strattice, or delaying the revision after removal and capsulectomy.

Francis (Frank) William Rieger, MD (retired) · Answer

It is certainly possible to have capsular contractures more than once after a breast augmentation, and this will happen with greater frequency after a previous experience statistically.  It has been shown that staying under the muscle with a breast augmentation can lower the frequency for a capsular contracture, whether smooth or textured surface implants are used, and if your Plastic Surgeon might advise you  to have them  placed sub mammary consider using textured surface implants.  This may lower the possibility for having a capsule form.   A no touch technique can be used, and antibiotic solution placed in the pocket and washing the implants in antibiotic solutions will also help.Good luck to you.Frank Rieger M.D.  Tampa Plastic Surgeon

Brooke R. Seckel, MD, FACS (retired) · Answer

In the past patients who have correction of a capsular contraction with re-implantation had a 50% risk of recurrence of capsular contraction.Newer methods for treating capsular contraction which include total excision or removal of the capsule, capsulectomy, and replacement with textured breast implants wrapped with a biological membrane such as  acellular dermal matrix, may reduce the chance of recurrent capsular contraction.

Can you have capsular contracture more than once?

Answers (10)

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