Is It Common to Reuse the Old Breast Capsule when Going Larger in Cc's?

You should see a Board Certified Plastic Surgeon for this problem.  Usually, a capsulotomy on some level is performed, but each case is unique.  This is not a case for someone not familiar with these problems, thus the reason I recommend you see a Board Certified Plastic Surgeon.  If your surgeon is not comfortable with the problem, then see at least 1 or 2 Board Certified Plastic Surgeon and evaluate their opinion.  To remove a capsule usually takes 2-3 times the time to put the breast implants in the first place, so yes it will be expensive.

Ciera, it has been my experience that after deflation, the capsule begins to contract and get smaller and the longer the time of deflation, the smaller it gets and the harder to open it up. And you went 100cc bigger as well so the capsule probably needed a bit of work, either aggressive capsulotomies, neo-capsulization, as described by Dr. Laverson, or some degree of capsulectomies. But having this degree of hardness right after surgery seems to indicate too much untreated old capsule.

I may not understand the problem completely but if the only problem you had was a deflation, and the only thing your surgeon did was to exchange a larger implant for the deflated implant, without either taking out the previous capsule, or performing multiple capsulotomies, than "yes" I think your pain is due to "reusing" the old capsule. It should be logical that stuffing a larger implant into a small space won't work well. On the other hand if there were other issues in play such as implant malposition, thin skin, or other things that made your surgeon concerned about controlling the location of the new implant, than "reusing" part of the capsule (neo-subcapsular) has become a commonly used technique. Hope this helps and doesn't make you more confused.

It is difficult to respond to your specific circumstance without more information.  Was your initial implant saline or gel?  If gel was ruptured and capsule was not removed, then you likely have residual silicone that may be contributing to contracture.  It is common to create a virgin pocket anterior to an old capsule, a technique popularized by Dr. Patrick Maxwell.  This applies to patients, in my opinion, with non-calcified capsules with intact implants.  Otherwise, my preference is to remove the old scar (capsule) prior to placing a new implant.  Replacing a new implant into a contracture is generally not recommended.  It sounds from your narrative like you did not have a contracture on the replacement side, just a ruptured implant.  In this case, it is not uncommon to remove the ruptured implant (if it is saline), open the capsule to develop a new pocket, and place the new implant in the new pocket, which incorporates elements of the old non-contracted capsule.

Without knowing more about your situation and exactly how your procedure was done, it is impossible to answer completely.

Whether one's existing breast implant capsule is maintained, released or removed during an implant replacement/exchange depends on numerous factors. If it is a simple implant exchange due to deflation and the previous implant position was satisfactory and the new implant will not be appreciably bigger, then the implant capsule would be maintained. If the implant exchange involves a significantly larger implant, then the implant pocket would be enlarged by doing capsular releases. If the existing implant capsule had prior problems (capsular contracture, calcification) or the implant has previous positioning issues, then the capsule would be removed with the implant exchange. These are general guidelines that may change based on each patient's circumstances and other factors including the quality and thickness of their breast tissue and overlying skin.

Your time line and explanation is not clear. If your main question is the capsule removal and reuse , I would say that it will depend on the surgical finding. Your surgeon may had concern about blood circulation and thickness.

You can't form a capsule in three days. You must have had a hematoma which isna collection of blood. I would talk to your surgeon and make sure they are Board Certified. Andrew Cohen, MD

You don't say whether you had a contracture (CC) before the deflation. Also important is how long the deflation was present before your surgery. With a deflation, the pocket will usually shrink. If you had a contracture before the deflation, the capsule should have been addressed during your surgery. Depending upon the severity of the contracture, either a capsulotomy (releasing the capsule) or a capsulectomy (removing the capsule) should have been done. If CC was not present and the pocket just shrank in size, a capsulotomy would have sufficed. Even without shrinkage, when you place a larger implant into a pocket, the capsule needs to be loosened up or else it will be too tight. 

 

I think that the chances of recurrence of a significant capsular contracture (grade 3 or 4) are reduced by placing implants in a virgin location, especially if they were originally placed above the muscle.  Even if the original implants have been placed submuscularly, I would try to dissect a new pocket between the anterior capsule and the muscle.

The best way to treat a breast capsule during implant exchange depends upon several factors, the severity of the capsule being extremely important. In the case of having a Baker Class IV capsule (a breast implant capsule causing visible changes to breast appearance plus associated breast pain or tenderness), you were experiencing the most severe manifestation of this problem.

It isn't really possible for a Baker Class IV capsule to develop within 3 days of breast augmentation surgery, but when revision surgery, in the form of a breast implant exchange, is carried out with placement of the new implant into a position surrounded by the old implant capsule, quick re-formation of the capsule is a definite possibility.

Because of this known fact, there are established procedures for handling a prior capsule when placing a new implant. These recommendations can be ranked by complexity, effectiveness and cost, as follows:


Place the new implant into the old capsule, after weakening the capsule with multiple incisions to break up its tightness (capsulotomy). This is the least successful way to overcome a capsule problem, but it is least costly, and occasionally it succeeds. This method is frequently used when changing to new, larger size, implants.

Remove a large portion of the old capsule before placing the new implant into the capsule space (partial capsulectomy) or remove entire old capsule (total capsulectomy). Sometimes portions of the capsule are permitted to remain and hopefully provide reinforcement to maintain good implant position.

Put the implant in a new space, not into the old capsule space. This may be accomplished by changing the implant position from behind the muscle to in front of the muscle, or visa versa.

Create some of the new implant tissue coverage using a relatively new product derived from specially prepared animal collagen (Acellular Dermal Matrix). This has recently shown promise as being and effective way to avoid a capsule. Unfortunately, this is the most expensive of the methods!


From your description of your problem, it sounds as if your surgeon attempted solving your deflation & capsule problem, using one of the less costly options. If that has now failed, it's logical that you would next be offered a more involved (also more costly) approach.

I hope this explanation helps!