Concerns About Downsizing and Reoccuring Capsular Contracture?

I had 700 cc memory gel implants put in 4 months ago along with a tummy tuck and lipo on my arms, thighs, stomach , lower back and butt. Everything healed fine, but now I have developed capsular contraction in my right breast. II am getting it replaced on July 10 , and since I am already going in for surgery I was thinking about going down a couple of sizes. I am concerned that since I already got cc once, what if it keeps happening, and how will my skin bounce back?

Doctor Answers 5

Concerns About Downsizing and Reoccuring Capsular Contracture

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

It is possible to #downsize to smaller implants and also alter the positioning; if possible. However, decreasing is size may also require a Breast #Lift to #tighten loose skin, better optimize the end result. Any #revision has risks of unhappy outcome or other complications. Also, the right implant for the revision is contingent on shape of body and your desired outcome.

One of the most common problems is breast #capsular #contracture or the development of thickening, and contracture of the capsule that exists around the breast implants. Severe capsule contracture probably occurs in less than 15% of augmentation patients.

Every woman has a breast capsule around their implant and this is a normal phenomenon. Nicotine users, such as smokers, have up to a 30x increased risk of capsular contracture.  As it thickens and shrinks, the patient may develop a feeling a firmness of the breasts and in its worst situation, the breast may become painful and abnormal in appearance, achieving a very round, hard, and uneven appearance. There may be distortion and possible breakage and leakage of an older implant, but may also include a newer #implant.

The #reason capsular contraction happen is unclear. It's possibly caused by microscopic bacteria on the implant, a   collection of blood after surgery or perhaps it is a tendency for some women to form scar tissue. What we do know is that is cases reported have decreased from 25% to  5-10% or less. One way to attempt the prevention of it is to follow your surgeon's post op instructions as recommended and ask questions of your surgeon when healing concerns arise.
I suggest beginning with an in-person #evaluation with your original surgeon, or, with a board certified plastic surgeon. It is best select a plastic surgeon who is #board-certified and has a great deal of experience with breast #augmentation and the incision type, #implant placement, and implant type. Plastic surgeons who have specialized in breast surgery and cosmetic surgery are suitable to perform your breast augmentation.

Capsular contracture

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

There is always a risk that if you had a capsular contracture that it may occur again. Some surgeons will opt to use Strattice with the thought that the capsular contracture rate is low with the product, but it is quite expensive.

Preventing Capsular Contracture Recurrence

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

There is a higher rate of contracture after you've had one. Since we believe that there is a subclinical (in other words, not a symptomatic) infection, or at least a colonization of the capsule that causes the tightening to occur, I remove the capsule and put in a new implant. This minimizes the likelihood of recurrence. I find that the harmonic scalpel, which uses ultrasonic energy to cut, to be particularly useful in this surgery, as it allows for the least amount of disturbance of the surrounding normal tissues.

Going smaller at the same time is a good idea, but shouldn't have any effect on recurrence.

 

 

Recurrent caosular contracture

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Once a patient has had a capsular contracture ,there is a high rate of recurrence if the implants are simply replaced.

Today we are more familiar with the causes of capsular contracture and how to reduce the risk of recurrence

The following are some of the factors that need to be considered

Implant type ,Gel ,Saline or Adjustable saline with the option if  temporary overexpansion of the capsule following release

Capsulectomy v/s capsulotomy .Placement of acellular dermis or absorbable mesh

Implant placement  Sub glandular,submuscular or subfascial

Strict aseptic technique ,avoidance of powered gloves

Use of and placement of drains

Antibiotic ,antiseptic irrigation 

Post operative antibiotics, ultrasound,Massage avoidance of smoking and medications that cause bleeding

There is conflicting evidence that textured implants have a lower incidence of capsular contracture

Capsular Cotractures

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

I believe that CC are a result of a low grade infection.  In that case you need to have the capsule removed totally if possible. Releasing the capsule has a very high rate of recurrence.  Downsizing the implant should have little to do with the risk of recurrence but if you are too big then now is the time to change the implants out as it will save your money and time. 

 

The risk of getting another CC is in the neighborhood of 4% if your remove the entire scar capsule.

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.