Capsular Contracture is a condition in which the capsule surrounding the implant thickens and contracts, squeezing the implant making it overly firm or hard and often changing the shape and position of the implant. As the capsule contracts it moves the implant further up your chest wall making upper portion of your breast too large and unshapely. It is more far more common in nicotine users (e.g. smoking, vaping or nicotine gum or patches).
I wonder where the polyurethane implants came from. must be europe asia or south america. those manufactured in the US by aesthetech had silicone shells with scott foam sheet thin mesh glued to it. They were not satisfactory, as the mesh degraded and ultimately got hard in many clients. since they are prepectoral it is feasable to excise the scar capsule to prevent a polyurethane granuloma when placing new implants under the muscle although if they have in a long time the mesh have broken down or become deeply embedded in the scar capsule and removal may be more harmful than helpful. I presented a paper on the use of these implants in the 90's at the aesthetic meeting in boston. My conclusion was that I would not them use again which is not an issue as they are to my knowledge not available in the US.
Capsular contracture with textured over muscle. Smooth under muscle or polyurethane subglandular?
Avoid polyurethane breast implants Which have been taken off the market for good reason.Especially since you have already had a capsular contraction Your new implants should be placed underneath chest muscle which is a much better location to avoid capsular contracture.At a recent plastic surgery meeting of experienced plastic surgeons a survey was done and 83% of the surgeons present use smooth round silicone gel implants.
Recurrent capsular contracture
In my opinion and experience, the submuscular implant even if smooth will fare better long-term than even a polyurethane implant placed over the muscle. In the polyurethane implants that were used in the United States many years ago, it was not uncommon for that portion of the implant to delaminate or separate from the underlying smooth portion of the implant shell. This implant than would act more like a smooth sub glandular implant and was not immune from capsular contracture. Hope that's helpful.
The lowest risk of capsular contracture is in the subpectoral or dual plane position. The degradation of the polyurethane coating can result in toluene and other chemicals being releasing into the body. There is a reason that polyurethane implants are not approved in the USA.
Smooth round sub muscular
There are many advantages to sub muscular dual plane placement and very many disadvantages to sub glandular placement. I would see no indication to do anything but sub muscular. This can be best accomplished with the armpit approach. The most sophisticated approach to breast augmentation is through the armpit with a surgical camera (transaxillary endoscopic). Using this modern approach the space can be crafted under direct vision, with virtually no bleeding and no postoperative bruising. Most importantly, the shape of the breast is meticulously created. The other, older methods of insertion are technologically less advanced. Both silicone and saline implants can be placed through the armpit by a surgeon with skill and experience using this approach. The incision in the crease is the oldest method of placing the implants and puts a scar directly on the breast.
Subglandular silicone implant placement is the historical approach to this surgery, and was widely used in the 1960's. The implant edges are more visible, the risk of rippling is higher, the implant is in contact with the non-sterile breast tissue so the risk of infection and capsular contracture is higher. The interface between the breast tissue and the muscle is blurred so the implant interferes with mammography more than sub muscular placement. The blood supply surrounding the implant is worse so the risk of capsular contracture is higher. The support for the implant is less so there is more long term shape abnormalities and sagging. The look of a sub glandular implant is much less appealing than a sub muscular implant. The placement of sub glandular implants makes any subsequent revision surgeries more complicated and less successful. There are no advantages to sub glandular implant placement.
Thank you for your question. I am sorry to hear about your capsule contraction. If you have failed conservative therapy, only a revision surgery with new implants can treat your encapsulation. Polyurethane implants have a very low rate of capsule contracture but as you noted are no longer available in the US. I have no experience with polyurethane implants but would recommend using a textured device of some sort. I would defer to your surgeon regarding the safety of modern day polyurethane implants. With regard to pocket location, we do have evidence that a submuscular pocket lowers the risk of capsular contracture, particularly with smooth implants and very likely with textured implants as well. If you are looking for the most natural result with the lowest rate of encapsulation, you should consider a submuscular pocket with some sort of textured implant. Good luck.
Treatment for capsular contracture
Here in the US we would recommend a pocket change to partial submuscular implants, either smooth or textured silicone implants. Polyurethane implants were game changers when they were introduced here in the US but I have no experience using them.
CC is always a challenge to manage. Usually for primary contraction, I would like a pocket exchange to submuscular but that may require use of ADM.I would also change your implants to a new breast implant textured or smooth.Best Wishes,Nana Mizuguchi, MD