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

Question

I am about 4 months post op. Currently have smooth silicone unders. I will have my revision soon for CC (grade 3/4) but still cannot decide on whether to go w/textured or smooth again. I know textured is designed to prevent CC but based off research the results seem to be inconclusive, which leaves me confused on what to choose. Doc recommends textured but I am still hesitant. Help please!

Gerald Minniti, MD, FACS · Answer

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!

Ronald J. Edelson, MD · Answer

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.

Kenneth Hughes, MD · Answer

The more form stable implants have a lower incidence of capsular contracture as do capsulectomy procedures with the placement of acellular dermal matrices.Kenneth Hughes, MDBeverly Hills, CA

Jaime S. Schwartz, MD, FACS · Answer

I appreciate
your question.With Implants
under the muscle, there is less risk of capsular contracture.  Anatomic
implants tend to give a more natural shape with more nipple projection.  You should  inquire about the use of acellular dermal matrix and SIEF (simultaneous implant exchange with fat) along with the use of medical management all to help decrease reoccurrence of capsular contracture.

The best way
to assess and give true advice would be an in-person exam.  Please see a
board-certified plastic surgeon that specializes in aesthetic and restorative
breast surgery.

Best of luck!

Dr. Schwartz

Payman Danielpour, MD, FACS · Answer

I am sorry that you are experiencing a CC but there is hope especially if you are seeing and being treated by a board certified plastic surgeon that has experience with CC.  The new treatment that has shown a very low recurrence rate is to perform a complete capsulectomy, followed by placement of an ADM (acellular dermal matrix).  The type of implant is not as critical as once thought.  Best of luck

Stuart A. Linder, MD, FACS · Answer

We only use smooth silicone gel implants for cosmetic breast revision with aggressive open capsulectomy. Best of luck.

Milind K. Ambe, MD · Answer

I think the evidence for whether smooth vs textured implants limits the recurrence of capsular contracture is inconclusive.  I would recommend a capsulectomy, placement of a drain, use of a new implant (usually smooth) and possibly starting on a medication like Singulair is helpful to avoid recurrence.  I would need a more detailed history of your situation to determine if anything else is necessary.  Make sure you see a board certified plastic surgeon who performs a lot of revision breast surgery.  Best of luck to you

Tom J. Pousti, MD · Answer

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.

Frederic H. Corbin, MD (license restricted) · Answer

Thank you for your question and I would ask your surgeon about the use of an ADM or Seri to prevent recurrenceDr Corbin

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

Answers (9)

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