Should I have a capsulectomy, capsulotomy, or just continue massaging? (photo)

I had my BA almost two years ago. Saline, sub-muscular, with 370cc in the left and 380 cc on the right. A month after, PS recommended massage for the left, which was not dropping and very hard. I was able to soften it but didn't realize the right was beginning to harden. At my one year checkup, PS recommended laser treatment for right breast, which I did once or twice a week for one and half months. Now right is hard again and higher. Should I consider surgery or try laser again?

Doctor Answers 10

Breast capsular contracture

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My experience is that massage does not help with capsular contracture. It is used to prevent it, but doesn't work once there is an established contracture. I have had great success with the use of Singulair 10 mg twice a day for 2 months. That works in a about 30-50% of cases, but they are usually mild contractures. Yours appears to be more of a Baker grade 3 CC. In your case, there are a number of options. You can try just a simple capsulotomy since this is your first CC. The recurrence rate is higher, but this will work in over 50 %. The next option is a partial capsulectomy with or without an ADM (Acellular Dermal Matrix) like Strattice or Alloderm. ADM's do diminish the recuurence of CC dramatically, but are quite expensive. I do use them for recuurent CC very commonly, but try the other methods first. I hope this helps.

Capsular Contracture

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I am sorry about your capsular contracture of your right breast. With all do respect to your experience, lasers, straps, massage, and ultrasound have never been shown to be effective in either prevention or treatment of capsular contracture in clinical studies.  In other words, your left breast would have softened had you done nothing to it.  I've not asked a patient to massage in over 10 years, yet my rate of capsular contracture has fallen - not because of the lack of massage, but because of other things that have changed as well.

Singulair has had lackluster results when examined in clinical trials. It fails statistical significance in most studies, however a few showed modest efficacy.  In practice, Singulair, when it actually worked, managed to only soften a breast, never could it drop it back into its proper position.

I do not recommend either closed or open capsulotomy.  You will be at high risk for recurrence. I do not recommend using expensive ADMs like Strattice or Alloderm, they are usually unnecessary.  In all likelihood, you will be completely cured with a total capsulectomy and replacement with a new implant.  It is a more time consuming and technically difficult surgery to perform well, but it is well worth it!

Best of luck!

Capsulectomy, Capsulotomy, or Continue Massaging

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One of the most common problems is breast capsular #contracture or the development of thickening, and contracture of the capsule that exists around the breast implants. Severe capsule contracture probably occurs in less than 15% of augmentation patients. Every woman has a breast capsule around their implant and this is a normal phenomenon. The capsule itself could be as thin as Saran Wrap but may also become calcified and thickened. As it thickens and shrinks, the patient may develop a feeling a firmness of the breasts and in its worst situation, the breast may become painful and abnormal in appearance, achieving a very round, hard, and uneven appearance. There may be distortion and possible breakage and leakage of an older implant, but may also include a newer #implant. Nicotine users, such as smokers, have up to a 30x increased risk of #capsular contracture.

Saline implants may deflate spontaneously. When the patient has significant #symptoms, complete or partial leakage of their saline implant, or concerns regarding silicone leakage, it is recommended that the implant is removed and exchanged. Frequently, this is performed on both sides depending upon the age of the implant. Capsulotomy or opening of the capsule may be required or frequently capsulectomy, which is removal of the scarred capsule, is r#ecommended to ensure adequate pocket dimensions.

New implants may then be placed in the same existing position or may undergo a change of #placement frequently from submammary to subpectoral position and, on occasion, the other way around.

Hard saline implants

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Saline implants under the muscle rarely develop significant capsular contracture.  Often, saline implants may feel too hard if overfilled too much or if the space was not made large enough.  Only an in person exam would determine if that is the case in your situation in which case the correction is simple.  Laser is a waste of time.

I would recommend surgery

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i don't believe that lasering would likely be of any benefit. Once the capsule contracture 
has occurred massage will not be helpful. i think you will have to consider surgery.
realize that capsule formation can recur. you may want to consider switching to silicone 
implants as well.

much success 
david berman md

Breast implants silicone implants breast capsule Baker grade 3 capsular contracture

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I'm sorry you're having so problems with your breast implants. Breast capsular contracture is not a common complication after breast implantation. To minimize capsule contracture typically silicone breast implants are used in a submuscular position. Since you have tried massaging, and even lasering, I would suggest your next step be surgery. From your pictures and your history, you are a Baker grade 3 capsular  contracture. I would undergo bilateral capsulectomy with removal and replacement of bilateral implants. I would also place the new silicone implants in a a different position, namely a subglandular or above the muscle position. Please discuss with your plastic surgeon various options. I often get medical insurance to cover removal of breast implants and capsulectomies. 

Should I have a capsulectomy, capsulotomy, or just continue massaging?

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As a over the internet guess I would lean toward re operation of a capsulotomy for your right breast... 

Should I have a capsulectomy, capsulotomy, or just continue massaging?

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At 2 years postop, the scar tissue forming the capsule is mature and established and nothing short of a surgical procedure is going to get the results you want. The dru Singulair works in almost all patients to soften the capsule to some degree, but will not get your implant into the proper position.

Capsular contracture

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Thank you for your photos and your questions and I agree totally with Dr Chasan's advice

Dr Corbin

Massage ineffective for capsular contracture

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Massage will not improve capsular contracture, and there is no good evidence that it can prevent it. Laser treatment is experimental. The most effective method is surgery with removal of the scar capsule (capsulectomy), replacement of the implant, and a Strattice internal bra.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.