1 year post op, doctor recommends a closed capsulotomy. I'm concerned the cc will return. What is the risk?

Back in the day, all plastic surgeons in the 80's did closed capsulotomies.  Closed capsulotomies were ways of squeezing hard on the breast in order to tear the capsule, which then led to an immediately softer breast, with also potential bleeding which would lead to even a harder breast.  There was also the potential for ripping the cover of the implant.  I have literally done hundreds of closed capsulotomies, all of which got hard again.

Closed capsulotomies fell out of favor in the 90's due to the high rate of return of the capsular contracture, i.e. tight scar around the implant, and also to the potential dangers of bleeding and tearing the implant covering.  The definition of insanity is doing the same thing over and over again expecting a different result. 

Capsular contractures are a big deal and should not be taken lightly.  If you have a capsular contracture, you want to make a full court press at dealing with it the first time as each time you try and fail, the contracture gets worse and worse. 

If you were my patient, I would switch the implant from superpectoral to subpectoral as subpectoral has a much less chance of getting a capsular contracture.  I would place ADM (a cellular dermal matrix) at various places around your implant (as this is known to decrease capsular contracture).  I would also place you on Accolate (now generic Zypherlucast), which is a medication known to decrease the chance of a capsular contracture which is an immune phenomenon, since Accolate is known to modulate the immune system and decrease capsular contractures not only around breast implants but also around artificial hips, pacemakers, etc. 

Closed capsulotomy procedures are not recommended as they can cause implant rupture, internal bleeding, distortion and other complications. Off label usage of Singulair may be your best bet and if this does not work capsulectomy, change of implant and its pocket and other options are more acceptible techniques to deal with your problem. It also voids the manufacturers warranty. Discuss with a board certified plastic surgeon.

Definitely against closed capsulotomy to treat implant contractures. Recurrence is high, damage to the implant and your breast tissue can occur and it's not the recommended treatment.

Medications (accolate, vit. E) and massage should be tried for 6 months and then capsulectomy, etc.