Capsular contracture, do I need complete new implants, if I am undergoing surgery for a capsular contracture?

The goal for a capsular contracture surgery is to re-create an entirely fresh pocket: remove the old implants, remove the thickened scar tissue entirely, replace with new implants, use drains, and consider the use of an ADM if this is your third time with this problem.  Good luck to you!Thomas Taylor, MDPasadena, CA

Yes, you do need new implants.  This is because one of the main reasons of developing cc is a mild, smoldering bacterial contamination of the implants, and so any revision needs brand new implants to minimize the chance of recurrence.  If you have new implants, all 3 manufacturers offer cc protection plans and you may be eligible for free replacement implants.  Best of luck.

Hello,I would like to clarify something here.  There has been a wealth of literature looking at revision and primary breast augmentation with regards to capsular contracture. The only controversy is in surgeon's heads. The data is clear, and its all about bacteria:1. Revision surgery should be performed through an inframammary incision, even if a periareolar scar exists.2. Total capsulectomy en bloc (all in one piece, no holes made while extracting it) should be performed with the implant discarded. 3. Triple antibiotic irrigation with half strength Betadine, followed by re-cleaning skin and re-draping operative field.4. Delivery of a new implant via a funnel.When the surgery is performed in this manner, your risk of recurrence is no more than when primary breast augmentation is performed in the most optimal way, approximately 2%.  Therefore, there is no need for expensive ADMs like Alloderm or Strattice.  In fact, this surgery is so effective, that the resulting capsule is frequently softer than the non-problematic side, and consideration preoperatively should be made to perform bilateral capsulectomies. Revision surgery is much different than primary, and you might benefit from getting a few second opinions. Best of luck!

There is no single correct answer for this. We suspect that in most cases of capsular contracture, a slow infection, called a biofilm, is present. So theoretically the implant is contaminated and perhaps should not be used. Some doctors will exchange implants in a more severe contracture but consider reusing the implants after a bath in antibiotics, with a lesser contracture.

Hi,

Thanks for posting your question. I am happy to try and help
you. It is important to remember that a board certified plastic surgeon will be
your best resource when it comes to an accurate assessment of your situation,
and concerns.

Having said that, capsular contracture is a very unfortunate
condition that may develop after breast augmentation surgery. The cause is an
enigma and we have some suspicions that it may be caused by subclinical
bacterial infection, or excessive bleeding during or after surgery. The
treatment is also complicated and some PS will through the kitchen sink at it
trying to make it go away. Some times it works, other times it does not.
Ultrasound, asthma medications, reoperating, scar tissue removal, changing to a
different breast pocket, new breast implants and even implant removal have been suggested to treat
it. The other problem is that it may go away after all of these heroic efforts
only to have it return. In other cases, one of these may work and it does not
come back. It is a tough problem.



I hope you found this helpful. Best wishes

you should use new implants, a new pocket, no touch technique, antibiotic irrigation and if you want to throw everything at it, then consideration of ADM's such as Strattice but this can get quite pricey.  Can you use your same implant?  Certainly, as its been done in the past with successful outcomes using aggressive capsulotomies and the same implants despite the current knowledge about bacteria and biofilms.

Hello,Most of us who perform breast implant surgery have had the experience of successfully treating a young capsular contracture (one that occurs within 2 years of the initial surgery) by addressing the capsule and using the same implant.  Recently all three implant manufacturers/distributors started offering warranties for Baker III/IV capsular contracture.  The coverage term ranges from 3 to 10 years depending on the manufacturer.  Therefore it sounds like your implants should be covered for free replacement.The reigning theory on capsular contracture is related to inflammation caused by the presence of biofilm, which is produced by bacteria.  It is not an infection however.  But we don't know enough about capsular contracture and there is likely more to the story.  Keep in mind that it is impossible to avoid bacteria in breast implant surgery since the ducts in a woman's breast tissue contain bacteria by definition, and this breast tissue will contact any implant that is placed.In summary, if it is possible, then replacement is the way to go.I hope this is helpful

This is a matter of some controversy.  Current thought is that the cc may be caused by bacteria in the "biofilm", the capsule that forms around the implant. Some hold, without much in the way of data to back it up, that the "contaminated" implants should be replaced.Sounds like you have already answered your question, and replacing the implants seems judicious.All the best. 

Thank you for your question and if your implants are under warranty the company may replace them at no cost but I would also look into the use of an ADM to prevent CC recurrence Dr Corbin

You do not necessarily have to replace the implants but it depends on the cause of your contracture.Implant type, texture, placement, surgical technique, etc. all effect outcome.All things being equal, in my experience as there is no definitive or absolute scientific opinion every single time, you have to change something when you operate on a capsular contracture otherwise you have an equal if not greater chance it will happen again.Further, in my practice, I tell patients to wait up to 2 years to operate on capsules unless there is visible distortion which progresses over time or pain.  In other words symptomatic contractures.  Capsules can soften months and months afterward.   Now implants misplaced during the original operation is a different thing.  If they are sitting too high that is not necessarily a capsule. Also assymmetries in placement.Take your time, ask lots of questions.  Good luck!Best.