350cc Mentor Silicone Moderate Subglandular, Left Capsule Contracture. Need Revision/Lift? Submuscular? ADM? All three? (photo)

Original implants in 1999, 2003 had a rupture (left breast), replaced w/new, 2006 had a Grade III capsular contraction (left breast) - & found out surgeon replaced w/same implant in the same pocket after getting MOST of the capsule out. Fast forward....I have capsular contraction (left breast), & pstosis....(no kids), lots of space in middle & sagging.....I'm told I need a full anchor lift by a few, & ADM would be helpful (very active) &larger implant desired 2 get a better look ....

Doctor Answers 6

Breast augmentation revision

Thank you for your question and helpful photos.
I'm afraid larger implants will not help you. Larger implants will increase your risk for CC and skin stretch deformity. You may want to consider removing implants altogether as they will continue to be a cause for seeking revisionary surgery. Breast implants are not life long devices and as such require maintenance (revisionary surgery) to keep them in place. I'm sorry you've had such a troublesome outcome. I find that most women in your predicament do much better with complete removal and undergoing The Horndeski Method breast lift. My technique does not require a vertical scar nor breast implants to create upper pole fullness.
I hope this helps.
Best wishes, 


Texas Plastic Surgeon
4.7 out of 5 stars 209 reviews

Revision for Capsular Contracture?

Yours is a difficult problem. It is also a good illustration of why subglandular (on top of the muscle) implants have a significant risk of capsular contracture, which when it happens, can be very difficult to correct - as you have learned with the recurrence of the capsule. Minimizing the recurrence of capsular contracture generally requires removal of the capsule, putting in a new implant, and if the original was in the subglandular plane, then switching to submuscular position.

Correction now should at minimum include a new implant and switching to the subuscular position. It may also be worth switching to a textured surface implant which have a lower risk of capsular contracture. Adding ADM may further lower your risk of recurrent capsular contracture, but I don't think that this is a proven concept, and adding ADM will seriously bump up the cost. Removal of the capsule along with the old implant is also important as it will allow the breast tissue to heal back down to the muscle and potentially increase the blood supply to your breast tissue. This will help reduce the risk of nipple loss if you need a breast lift, but it requires doing the lift at a second operation. Or, if appropriate, go with a vertical or lollipop lift which will tend to have a lower potential risk of nipple loss.

If you see several surgeons it is likely that will get several different opinions on how this should be fixed, and I don't think that there is an absolute best way to manage this. You should definitely look for a Real plastic surgeon who is certified by the American Board of Plastic Surgery and who has significant experience in revisionary breast surgery. You should also not choose a certain surgical correction because it is the least expensive option. Cutting costs generally means cutting corners which too often leads to another recurrence, and that is something that you don't need. Paying more for a quality durable result will be worth it in the long run.


Recurrent capsular contracture

I would recommend new textured gel implants, move to under muscle with ADM preventing windowshading of muscle and a vertical lift. That, in my opinion, is the best chance for long term soft result. Good luck.

Options

There are several options that you can have.  If you have a cc, then an implant exchange and capsule removal will be helpful.   The type of lift will depend upon how much loose skin you have.  A lollipop lift may be reasonable.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

Capsular contracture

Your best option to avoid recurrent capsule is to switch the new implant to a submuscular position.  ADM may be added to support the muscle position over the implant.  Your nipple/areolas are low and a vertical lift would also be indicated, depending on how large you would like to go with your new implants.  Best wishes, Dr. T. 

Many options to consider

Your first choice is to find a plastic surgeon you can trust.  You have certainly had a few operations on your breast and would like to have one that lasts a good 10 to 15 years.  While I can't determine What you would need without an in person consultation there are several thing I definitely would have you consider.  First of all I would change the implants and try to put them in a new pocket either over or under the muscle, preferably under.  I would consider using ADM as there are studies that seem to show reduction in the risk of capsules and I would do probably a vertical lift.  I don't think you need a full anchor lift and it is rare that I even do this on breast reductions.  You probably want to see several board certified plastic surgeons with experience in re-do breast surgery.  God luck, Dr. Schuster in Boca Raton.

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