Is a capsulectomy only performed on the side with capsular contracture or is it standard to do both? (photos)

Generally I if there is an issue with capsular contracture on only one side, and the other breast remained with excellent form and without issues, I would focus treatment to that breast only. Most women getting breast augmentation by plastic surgeons love their new look. However, complications sometime arise and getting a thorough evaluation by a Board Certified plastic surgeon is essential. It appears that you have a capsular contracture, which can certainly be corrected by a surgeon with sufficient experience and expertise in revision breast surgery. I hope this was helpful. Please let me me know if you have any other questions regarding the procedure. Thank you and best of luck. Dr. Campbell

Since your implants were placed in 1991, they are now approximately 25 years old. These are also several generations removed from the current technology of breast implants. This alone is an excellent reason to have your implants replaced on both sides. In regards to your capsular contracture, you should consider using a tissue matrix, such as Strattice, on the side that has a capsular contracture. This is because the recurrence rate of capsular contracture in patients such as yourself, undergoing capsulectomy and replacement of the breast implant, is between 50-70% within the first year. I would highly recommend that you have a consultation with a Board Certified plastic surgeon with experience treating these types of issues.

It would be best under these circumstances to have the capsule removed on both sides.  This would allow for better symmetry.

Capsular contracture is the result of aggressive scar
capsule formation and contracture around the implant. Although all breast
implants have a capsule, occasionally the capsule becomes thick and firm. When
capsule tightens around the implant it can cause the affected breast to become
hard and painful (8-16%). The cause of capsular
contracture is unknown, however, bacterial contamination, rupture, and hematoma may be factors. The treatment for
contracture is usually surgery to release or remove the capsule around the implant. The unaffected breast is typically left alone.



Breast implant rupture occurs when
the outer shell of an implant develops a hole or tear. It occurs in about 10%
of breast implants. The rupture of saline implants often manifests in the
deflation of the affected breast as the saline leaks out and is absorbed by the
body. The rupture of silicone implants is often silent (asymptomatic), however,
some patients will complain of a change in shape, lumpiness, or new onset pain
on the side of the rupture. The FDA recommends that ruptured implants be
removed or replaced.



The best non-invasive test for
implant rupture is an MRI. It has an accuracy of 92%, a sensitivity of 89%, and
a specificity of 97% at detecting implant rupture. In real world terms, if a
rupture is seen on MRI the implant is likely ruptured (94%). There are some
ruptures, however, missed by MRI (5%).



Consultation with a plastic surgeon would be the next best
step.

Given the age of your implants, it is likely that you have rupture or
bleed of silicone with associated reactive, calcified capsules which
would require removal to restore your breasts to native, soft tissue. Since your not excited about replacing your implants, I
won't argue with your plan to explant, and then decide what you want once
your breasts have healed and recovered to a stable state; it is certainly a safe and conservative plan of action. Good luck and thanks for sharing.

First, you need to know that once you've done a removal of the scar tissue on the right, it may still feel different from the left. Many time the side having the surgery becomes softer than the normal side. Weird, huh? Sometimes I remove both sides of scar tissue, just to ensure evenness of softness.Second, I would strongly recommend getting those implants switched out because of how old they are. Even though they were great implants back in '91...

Thanks for your question and the photos. Although you have no symptoms, the age of the implant makes you at higher likelihood of having calcifications in the capsule. Sometimes the breast is soft, but the calcified capsule should be removed. I see no reason why you would need a lift. If you feel like you are going to want implants, I would replace them at the same surgery. Best of Luck!

 If you are pleased with the size of your breast implants there's no indication to perform a capsule ectomy on the one breast that is soft.

Thank you for your pictures. It it is important to treat the problem only. Capsulectomy is used in the breast that has a capsular contracture. If you have a ruptured implant in the other breast then that implant needs to be replaced.

Capsulectomies can be performed to improve capsule contracture and also in the setting of removing ruptured implants. If only one breast has a contracture, I don't think that there is any reason to have to do it on the other breast. If the other breast needs surgery beacause of a different reason, like a ruptured implant than that would be up to the surgeon. Maybe you should get an MRI to see if the other breast implant is ruptured.