Would you suggest smooth silicone or textured implants after capsular contracture revision?

Hello,The advent of anatomically shaped implants (and Sientra's round textured implants) has placed the concept of the textured shell surface back in the minds of doctors and their patients. There is little good evidence that textured shells decrease the risk of primary or recurrent capsular contracture when the implant is subpectoral. Similarly, there has been a rise in popularity in using biologics (ADMs and Seri) for the treatment of capsular contracture since the science around their use in mastectomy reconstruction shows lower capsular contracture rates. This has not been demonstrated well in augmentation patients.On the other hand, there are a number of more important maneuvers that will lower your risk of recurrence to very low levels (1% to 2%), perhaps lower than your original risk depending on how your primary surgery was performed. The keystone concept is removal of the entire scar capsule and implant in one piece and replacement of a new implant in a aseptic fashion.  This is done with a total en bloc capsulectomy through an inframammary incision. This incision avoids milk ducts and breast tissue that can re-contaminate the implant pocket, and allows for a generous enough opening to remove the entire capsule with the implant inside.  This is also important because in all likelihood there is bacteria on the surface of the implant and also on the inner surface of the scar capsule, both of which could also re-contaminate the pocket if exposed. Finally, after meticulous hemostasis (cessation of all bleeding) and copious triple-antibiotic irrigation, a new implant is delivered using a 'no touch' method with an implant funnel. Obviously the things I mentioned are for the surgeon to know, but I'm telling you this because you should know that this is what's important, not the implant shell surface or use of expensive biologics like Strattice or Seri.Best of luck!

 I am sorry to hear about the complication you have experienced. Capsular contraction can be a very frustrating complication for both patients and surgeons. It is not unusual to received different opinions from different plastic surgeons. Ultimately you will need to do your due diligence and feel comfortable that the plastic surgeon you choose has significant/demonstrable experience helping patients with this type of complicated revisionary breast surgery.
I know of no science that demonstrates an advantage of using smooth versus textured breast implants, as long as the breast implants are placed in the sub muscular position.

In my practice, I have found the most success treating these difficult problems utilizing techniques such as sub muscular pocket conversion (if relevant), capsulectomy, use of fresh implants (I am not convinced that there is a difference with smooth versus textured implants as long as the breast implants are in the sub muscular position), 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). I hope this, and the attached link ( demonstrating a case utilizing acellular dermal matrix) helps.

Best wishes for an outcome that you will be pleased with.

Capsular contracture can be a frustrating problem to deal with once it has occurred.  There is no clear evidence which type of implant would be best in your case and I would advise you to discuss it with your surgeon.