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 9

Breast capsular contracture

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.

Del Mar Plastic Surgeon
5.0 out of 5 stars 31 reviews

Hard saline implants

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.

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 24 reviews

I would recommend surgery

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

David E. Berman, MD
Sterling Plastic Surgeon
4.9 out of 5 stars 76 reviews

Breast implants silicone implants breast capsule Baker grade 3 capsular contracture

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?

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

Capsular Contracture


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!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 78 reviews

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

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.

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 24 reviews

Capsular contracture

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

Dr Corbin

Frederic H. Corbin, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 58 reviews

Massage ineffective for capsular contracture

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.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 45 reviews

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.