Is it possible to have a capsulorrhaphy without having my implants removed?

Question

Hi I had a lift and large implants which were later removed as I got an infection. Then had smaller implants. They looked good at first but have now fallen down to where my big implants were, ending about an inch under my scar. I wish they were higher like they are when I'm wearing a bra. Can I have a Capsulorrhaphy done without having my current implants removed/replaced? Or would they need to be replaced? I never wanted small ones. Can I not just go back to bigger implants without a Capsulorrhaphy?

Jed H. Horowitz, MD, FACS · Answer

hello sacha34 This is a condition where the capsule around the implant thickens and squeezes the implant making it hard and often changing the shape and position of the implant. It is more common in nicotine users (e.g. smoking or nicotine patches or gum). Effective treatment of the capsule frequently involves completely removal of the capsule (capsulectomy), and occasional incisions in the capsule may be somewhat helpful (capsulotomy). In the past, closed capsulotomy, in which the breast is squeezed until the capsule breaks, was used. Currently, most doctors avoid this technique because of complications associated with the technique and because the implant companies will void their warranty if this technique is used. At times it is necessary to change the position of the implant, either above or below the muscle, depending upon the initial position, changing the implants themselves and, on occasion, the use of Acellular Dermal Matrix (ADM) may be required to prevent continued problems. Although the published risk of capsular contracture is approximately 9-11%, in our practice it is somewhat lower after initial implant placement. Once capsular contracture occurs, the risk of problems with secondary surgery rises to between 25% and 40%. The use of Singulair and Vitamin E may be of benefit. If you had a Sientra Textured Implant placed as a primary procedure and a contracture occurs in the first two years after primary augmentation, then their implant warranty may apply.

Richard Baxter, MD · Answer

If the bottom of the implant is below the scar, then a capsulorrhaphy should be considered whether or not you decide on changing the size of the implants. Bigger implants will put more stress on the repair however. The implants need to be removed during the surgery but if you don't want to make a size change then they do not need to be replaced.

Ken Dolynchuk, MD · Answer

Thanks for the question. However, without a picture it’s a little hard to be specific. If the pocket is made smaller it will improve the situation. There are different ways to do this and in order to plan the best approach you should discuss this with your plastic surgeon. The cost can be lower if the original surgeon is willing to do this for you. Good luck.

W. Tracy Hankins, MD · Answer

You need an exam to know for sure what is going on but it sounds like your implants have bottomed out. In bottoming out cases, the same implant can be used after the repair or new implants can be placed. The capsule needs to be sutured to make the pocket smaller and act like an internal bra for the implants.

Connie Hiers, MD, FACS · Answer

The implants will need to be removed to allow work on or removal of the capsules. If you go back to large implants, you just may sag again due to the weight of the implants. Your surgeon who has examined you will be the best one to tell you what realistically can and should be done.

Is it possible to have a capsulorrhaphy without having my implants removed?

Answers (5)

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