Capsulotomy or Capsulectomy? Which Will Correct a Moderate CC?

7 months post-op from initial B.A. Developed "moderate" CC on right breast at 3 months post-op (implant never dropped and began to move up) and am now considering a revision. Have consulted with numerous surgeons who vary in recommendation to perform an open capsulotomy or capsulectomy. What is the best option? Will capsulotomy correct a moderate CC? Are the success rates for both procedures relatively similar, or is one significantly more effective than the other? Thank you!

Doctor Answers 5

Breast Implant Capsular Contracture Best Treated with Alloderm or Strattice

Capsulotomy or Capsulectomy alone to treat Capsular Contracture of Breast Implants will result in recurrence in about 50% of cases.

The best modern effective treatment for Capsular Contracture of Breast Implants is to remove the capsule - Capsulectomy - and cover the Breast Implant with Acellular Dermis. Allodern and Strattice are two common types of Acellular Dermis.

This technique is recommended by most experts today.

Capsulotomy or Capsulectomy? Which Will Correct a Moderate CC?

I have had success with both capsulectomies and capsulotomies with treatment of CC. In general I find it best to remove the capsule below the pectoralis muscle.  Scoring the capsule above the muscle will sometimes be beneficial as well.  I offer the use of Dermal Matrix to all my patients, but the added cost usually reserves its use to those with recurrences. 

Recommendations for early capsular contracture

Recommendations for early capsular contracture:

  • considor singular for 3 months. this is off label use but has about a 50% response rate
  • the simplest surgery for minimal contracture is capsolutomy.   less invasive can be done with local
  • worsening or recuurent consider capsulectomy with or without a graft
  • acellular dermis ie belladerm, flexiderm , alloderm

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 94 reviews

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Capsulotomy or Capsulectomy? Which Will Correct a Moderate CC?

Hello! Thank you for your question! It is a matter of surgeon preference as well as what is seen during your procedure that will determine whether or not a complete capsulectomy is performed. If significant capsule formation is seen intraoperatively, a full capsule removal may be warranted with a drain in order to completely remove all of the tissue and allow better adherence of your breast back to its normal anatomic position down on your chest wall. If minimal contracture is seen, it may be possible to leave the capsule, or place cuts within the capsule to allow better adherence. It truly is dependent on what is seen with your capsule and the issues that may be causing you to have such a procedure (e.g., contracture from ruptured implant vs pain vs simple pocket adjustment, etc). Implants may or may not be replaced depending on your discussion and reason for capsulectomy.

Without knowing your issues and without an examination, it is difficult to tell you what may be the best thing for you. I tend to favor performing capsulectomies (in an en bloc fashion) in order to create a fresh pocket, reshape the pocket, allow better shape and adherence of the overlying breast. I would discuss your issues with your plastic surgeon who will assist you in determining the right modality for you. Most patients tolerate this procedure very well with minimal downtime. It is typically an outpatient procedure with most being able to resume activities within a few days along with restrictions for a week or so. Many surgeons will recommend a postoperative garment for several weeks postop as well. Hope that this helps! Best wishes!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 22 reviews

Capsular contracture correction, best long term treatment

Thank you for the question. Capsular contracture (CC) is one of the potential problems with implants. The traditional way of dealing with this problem is capsulotomy, total or partial or if the capsule is thick is capsulectomy and implant exchange. There is a high recurrence rate with these procedures. A recent advancement in dealing with this problem is using tissue matrix. Alloderm, which is human dermal scaffold or Strattice, which is porcine dermal scaffold. The Alloderm can stretch over time, but the Strattice will not. Both give good long term results. In cosmetic breast surgery these materials have been used only recently, so we do not truely know how long the breasts stay soft. I have patients who are over nine months out without recurrence of the contractures. These patients were implant cripples with multiple previous procedures (capsulotomies/capsulectomies) without success. See a board certified plastic surgeon with experience in usung these materials for cosmetic breast surgery. Good luck.

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.