Second time capsular contracture. What is my best option?

Question

9 months ago I had implants replaced due to capsular contracture. The new ones capsulated to grade 2 and 3 within a couple of months. They were placed over the muscle both times. We used the same size. 325 cc. I needed a lift but opted out both times. They are high profile smooth implants. It has been suggested to do another release and breast lift or take them out and I will go from a full D to a B cup. Hard decision since I am 20 lbs. heavier than I was 23 years ago!

Kenneth Hughes, MD · Answer

If both revisions were placed above the muscle, the option of submuscular placement should be explored. The addition of the dermal matrices can be used in this, but the shift to a submuscular plane is a reasonable option.

Jed H. Horowitz, MD, FACS · Answer

breast revision for capsular contracture

	
		there are several options
	
		consider dermal sheeting of some sort   ie belladerm, 
	
		consider submuscular conversion
	
		form stable implant from sientra
	
		vit e and accolate

Raj S. Ambay, MD · Answer

Your question is very complicated. If there is a capsule then removal can completely change the dynamics of how an implant in a new pocket. That is both the shape, size and feel of the implant. Capsular contracture is not always preventable. It can occur due to an infection, radiation, or just the way and individual heals. Capsular contracture can be minimized from the surgeon's side by placing the implant underneath the muscle. This may be a a prudent way to go given that placing the implant above the muscle is known to have a higher rate of capsular contracture. Some surgeons advocate breast massage as away to keep an implant mobile in a capsular pocket. Truly because of the complexity, you should consult with a board certified plastic surgeon who is comfortable with complicated revisions of the breast.

Jourdan Gottlieb, MD · Answer

Sorry to read about this problem.

	You have several options. Most reliable would be to remove the implants. If you choose to try again, the implants would be better placed below the muscle, and a piece of acellular dermal matrix (Strattice) should be considered. 

	Depending on your band size (34, 36,38 and so forth) you might find that removal won't decrease you by two full cup sizes as you suggest. 

	Thanks for your question, all the best.

Steven Wallach, MD · Answer

Capsular contractures are sometimes tricky to deal with. It is thought that placing the implants under the muscle may be better. In addition using an ADM like Strattice may help diminish the risk as well.

Jeffrey Zwiren, MD · Answer

This is a tough situation and unfortunately there are not definitive answers. If your implants were placed above the muscle you may consider switching the site to below the muscle. There is also some evidence that using an acellular dermal matrix such as stratise made by Lifecell helps to reduce the incidence of capsular contrature. Your other option is to remove the implants completely and have a breast lift. Other options may include using a textured implant.

George J. Beraka, MD (retired) · Answer

Hi.

	Without examining you, my guess is that you should get rid of the implants and have a good lift and end up with small but nice breasts.

Second time capsular contracture. What is my best option?

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