I’m experiencing capsular contracture for the 3rd time! Undergoing Aspen treatment for CC. Level II borderline III (Photo)

Question

I’ve had four surgeries in a years time. After the initial augmentation, my right side ruptured, so I had a revision. Since then, I’ve developed CC three times and have had a Capsulectomy three times. I have saline sub muscular. I’m on the third out of ten Aspen treatments but my breast still feels firm and is sore and slightly misshapen. Advise? I’m desperate

Donald R. Revis Jr, MD · Answer

Good morning!Definitely one of the most frustrating problems in breast augmentation surgery! Here is my approach:1) complete capsulectomy to remove the scar tissue2) new textured implants3) drain for five days4) singulair 10mg beginning three weeks preop and continuing 9 weeks postop5) irrigation of the pockets with a triple antibiotic solution6) oral antibiotics and Vitamin E7) a sheet of Strattice on each sideIn my experience this gives the best reduction in recurrence risks. I have attached a link to my Breast Augmentation Revision photo gallery with lots of CC corrections for your review- hope it helps!

Gerald Minniti, MD, FACS · Answer

Hello,
Periareolar incisions impart the highest risk for capsular contracture. A well known fact, yet many surgeons persever and continue performing the surgery in this way. As time goes on however, more surgeons are switching over to the inframammary incision, a much safer incision that does not disturb breast tissue, avoiding other scar related deformities as well like areolar tethering (which you have too). Most revision breast specialists avoid periareolar incisions for this reason, and rely on the inframammary incision.  If your surgeon keeps using this incision, then one can only wonder if a total en bloc capsulectomy was performed, the most effective means of preventing recontamination of the implant pocket and recurrent cc. Bacteria is the problem, and the Aspen method, along with other non-surgical modalities like implant massage, high dose vitamin E, Singulair/Accolate, and antibiotics are all ineffective. I advice you to stop, and seek help from a revision breast specialist.  Best of luck!

Daniel Barrett, MD · Answer

Dear Flieshome,Capsular contracture happens. In fact, every implant has a capsule form around it, its just a certain percentage develop thick capsules. There is a lot we don't know about it actually. Some think that bacteria that gets on the implant during insertion can increase the risk. Thats why we use a Keller Funnel in our practice to reduce that possibility. Our capsular contracture rate is less than 2% because we use a keller funnel as well as meticulous operating room techniques.Daniel Barrett, MD, MHA, MS 
Certified, American Board of Plastic Surgery  
Member, Am. Society of Plastic Surgery

Richard Baxter, MD · Answer

Since you are on the third of 10 treatments with ultrasound, it is best to complete the course before deciding about next steps. Your options are unfortunately limited after multiple recurrences of capsular contracture. The best is to repeat the capsulectomy and implant replacement but add ADM such as Strattice.

Thomas Fiala, MD, FACS, FRCSC · Answer

I'm sorry to hear about your frustrating problem with recurrent capsules.  It's a very challenging problem.  If you've had a complete capsulectomy and new implants behind the muscle already by a experienced plastic surgeon, the next options are:1)  line the pocket with an ADM, like Strattice.  This reduces, but doesn't eliminate, the risk of a recurrent capsule.  Downside: expense2)  Remove the implants altogether - then consider either a lift (if needed) or possibly some fat grafting to the breasts to restore some of the shape and volume.  As you know, if you take the implants out, your body is not going to make any more capsules.  But that is a tough decision to make.Best wishes,

Tom J. Pousti, MD · Answer

I am sorry to hear about the complications you have experienced. Capsular contraction can be a very frustrating complication for both patients and surgeons. In my practice, I have found the most success treating these difficult problems utilizing techniques such as sub muscular pocket conversion (if relevant), capsulectomy, pressure antibiotic lavage of the "pocket", use of fresh implants, and the use of acellular dermal matrix. Acellular dermal matrix is a biologic implant that carries the ability to become integrated into native tissue. It is made by taking a full thickness section of skin from a donor source (his human, porcine, or bovine in origin). 
 
 Best wishes.

I’m experiencing capsular contracture for the 3rd time! Undergoing Aspen treatment for CC. Level II borderline III (Photo)

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