Second Capsulectomy, Need Second Opinion?

Hi, I had breast augmentation January of last year; April of the same year I had capsular contracture on my left breast so I had a capsulectomy ( Same implant was steriled and placed back in) that surgwry left my implant sitting slightly lower than my right but not too noticible. April 20th of this year I had another capsulectomy on the same left breast. I am so unhappy with the result. My breast is even lower. Dr says its fine.

Doctor Answers 4

Asymmetry after Capsulectomy

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I am sorry you are not happy with your results.  It is unfortunate that you suffered capsular contracture twice, and now your affected breast is lower. I have just a few comments to make about capsular contracture in general and also what happened to you.

Capsular contracture is still not completely understood, but it involves an individual's genetic predisposition to inflammation, caused by a number of triggers at the time of or after the surgery: excessive bleeding , tissue trauma, and/or bacterial contamination of the implants ('biofilm').  Implant message after surgery will not prevent it, nor will it treat it once it has become apparent. There are no known non-surgical ways of treating capsular contracture reliably or consistantly once it has happened, but some techniques that have been looked at include antibiotics, high dose vitamin E, Singulair/Accolate, and external ultrasound.  The most reliable way of treating capsular contracture and minimizing recurrence is by surgical removal of the entire capsule and implant in a way that there is no re-contamination of the surgical site with bacteria, and a new implant is replaced.

In my practice, I am very concerned about symmetry after a total capsulectomy, and I frequently recommend adjusting the other side if necessary, because it is common for the treated side to become lower than the non-treated side.  That might have been helpful for you.  I also never reuse an implant; you cannot resterilize it.  The potential that it has biofilm on it's surface is very high, and reusing it makes recurrence much more likely.

My philosophy and techniques to treat capsular contracture do not always prevent recurrence, nor do I always get perfect symmetry afterwards either.  However, data suggests that this is the best practice.  It is also the most expensive technique too, and many patients would opt for less (one sided surgery/re-use implant).  I no longer perform anything less, as it increases the risk of recurrence and therefore is more expensive in the end.

Again, I am sorry that you have not reached your goal yet.  If your doctor is content and you are not, you need to see another for a second opinion. Keep in mind that you have already spent a lot of time and money already, so choosing the most reliable option is now your best bet, and will be less costly in the end.

Best of luck.

Beverly Hills Plastic Surgeon
4.9 out of 5 stars 100 reviews

Breast Implant

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If the implant and the breast is too low then the pocket where the implant is low and needs to be closed to keep the implant up.

M. Vincent Makhlouf, MD, FACS
Chicago Plastic Surgeon

Second Capsulectomy, Need Second Opinion?

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CC is such a tough problem to fix but in patients that seem to have repeated issues I have been using Strattice as an interposition graft to help with the contracture and it sounds like it might help support the low position as well....The other possibility is a change in the location of the implants. If they are currently above the muscle, then change them to below if possible...Another option...

John J. Corey, MD
Phoenix Plastic Surgeon
4.7 out of 5 stars 48 reviews

Capulectomy and issues

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After two previous capsular cotracrtures, you have two option:  remove the implants for a few months and redo the surgery at a later time, or remove the capsule, implants, exchange implants, and add strattice.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 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.