Breast revision needed but unsure of what route to take.

I am a 40yo who had 390cc silicone implants placed over the muscle. I have a contracture of my left implant & possible rupture of my right implant. I have seen several doctors for consults & been given me different recommendations: a lift and a smaller implant (although I'm not sure about living with a scar at this point), or a slightly larger implant both over & under the muscle. I am not happy with the shape of either breast and I used to be happy with the size prior to the contracture.

Doctor Answers 4

Breast Augmentation Dilemma


Your aversion and misconception of scars after a breast lift may have been the cause of your current problems, based on the fact that your implants were placed over the muscle. If you are unhappy with the appearance of your breasts now, wait to see how unhappy you'll be when you let someone place implants under the muscle without a lift. Don't go down the long, expensive, and unhappy road of doing the wrong surgery by the wrong surgeon over and over again. Go visit a few ABPS certified/ASAPS member surgeons that specialize in revision breast surgery. You'll likely need bilateral total capsulectomies, replacement of new implants in the sub pectoral position, possible acellular dermal matrix placement to separate old from new pockets, and a breast lift. In return, you'll have soft and beautifully shaped breasts with inconspicuous scars. Best of luck!

Beverly Hills Plastic Surgeon
4.9 out of 5 stars 90 reviews

Capsule contracture and options

Thank you for your question.  I am sorry to hear about your implant problems.  Some photographs would be helpful and of course an in-person exam is always best.  With capsule contracture and rupture, most surgeons would recommend capsule and implant removal.  As far as over or under the muscle, you will likely get different opinions.  There is some evidence that submuscular placement may decrease risk of contracture.  Textured implants seem to decrease contracture when placed over the muscle. The capsulectomy may improve the shape, but it sounds like you may need a mastopexy for optimal control of the shape.  Best to pick the surgeon with whom you feel most comfortable.  Ask if they have any before and after photos of patients who have been in similar situations.  Good luck.  

Matthew H. Steele, MD
Sioux City Plastic Surgeon
5.0 out of 5 stars 85 reviews

What to do

With a history of a capsular contracture already and a possible broken implant, in my opinion, you are at a very high risk for another capsule should you choose to place another implant on top of the muscle. I would recommend that you place the implant below the muscle and use a piece of Strattice connected to the muscle down to the breast crease to make a complete new pocket. What to do with the overlying breast tissue, as far as a lift goes, is totally dependent upon what you look like. This is a procedure that I like doing because it addresses all of the issues in one operation. Best of luck.

Marc J. Salzman, MD, FACS
Louisville Plastic Surgeon
4.7 out of 5 stars 54 reviews

10 plastic surgeons and 10 different answers

I have always said if you want 10 different answers, just ask 10 different plastic surgeons!  There is never a "right answer" when talking about breast implant revision procedures.  You have done the right approach by talking with several different plastic surgeons, now you need to decide which surgeon you feel the most comfortable with and what approach you can live with (scars, implant size and style, location of implant, cost, recovery, etc).

Good Luck!

David Finkle, MD
Omaha Plastic Surgeon
4.9 out of 5 stars 75 reviews

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.