Capsular contracture grade 4, what are my options if I cannot afford Alloderm ?

Question

Silicon implant 375cc and 420cc placed over the muscle 1,5 months ago. Had pain and yellow discharge coming from the incision after a surgery on my left breast ( which eventually developed cc) . I went to my doctor one month later complaining for pain, hardness and change in breast shape he diagnosed me cc grade 4.Now Im taking Singular and some inflammatory drugs, tried to do Aspen therapy, but they told me it won’t help. So my doctor wants to perform capsulectomy, but Im scared cc will happen again.

Gerald Minniti, MD, FACS · Answer

Hello,As in your case, bacterial contamination of the implant has a substantial if not singular role in the development and perpetuation of capsular contracture. You may stop Singulair and NSAIDS, they will not help, nor will high dose vitamin E or antibiotics. Unless you are in severe discomfort, you should wait 3 months from surgery to have a total en bloc capsulectomy via an inframammary incision. If your surgeon isn't an ABPS certified/ASAPS member surgeon who specializes in revision breast surgery, you should find someone who is. This is a difficult surgery to perform correctly. Best of luck!

Daniel Barrett, MD · Answer

Dear Nataly93,capsular contracture happens. In fact, every implant has a capsule form around it, its just a certain percentage develop thick capsules. There is a lot we don't know about it actually. Some think that bacteria that gets on the implant during insertion can increase the risk. Thats why we use a Keller Funnel in our practice to reduce that possibility. Our capsular contracture rate is less than 2% because we use a keller funnel as well as meticulous operating room techniques.Daniel Barrett, MD

Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

James H. Rogers, MD · Answer

There are a number of things which can cause capsule contracture, or hardening,after augmentation. Infection is one of them. When the problem is to the extent of yours , or grade 4, surgical intervention will be required. An open capsulotomy, with the removal of the implant will be necessary. If there is evidence of infection, the implant should not be replaced, and an appropriate waiting period is necessary before placing a new one. If there is no evidence of infection, replacing the implant in a new submuscular pocket will reduce the chance of recurrence. While effective, Alloderm is extremely expensive and rarely needed.

Mathew A. Plant, MD, FRCSC · Answer

It sounds like you had an infection which could easily cause this. If that is the case then a capsulectomy would be a very appropriate treatment. Alloderm is helpful, but if you have had only one CC and there is a reasonable explanation for why it happened then its unlikely that you'll have a recurrence unless the same conditions occur again. Best of luck!

Dallas Buchanan, MD · Answer

Thank you for your pictures and questions. Sorry to hear that this happened to you. I would agree that you are at increased risk of repeat capsular contracture and that ADM would help, but it is not a requirement. There are other options out there for you. I would advise a revision with removal of the previous implant and capsule, as well as transition to a submsucular implant. Talk with a local board certified plastic surgeon about your options.Best of luck!Dallas R. Buchanan, MD, FACSOwner & Board-Certified Plastic SurgeonVIVIFY plastic surgery

Thomas Fiala, MD, FACS, FRCSC · Answer

If this is your first capsule, your chance of success with conventional treatment (capsulectomy and plane change to submuscular) is about 80-85%, according to the data presented by Hidalgo, et al.  If it's your second capsule, success rate drops to about 60%.The success rate is higher with ADM.  While ADM is expensive, it's cheaper than another repeat surgery when the capsule comes back.

Jeffrey K. Scott, MD · Answer

I'm sorry to here about your left breast capsular contracture. The fact that this developed relatively quickly and was associated with some external drainage could mean that a low grade infection is/was present. I would suggest your Dr. culture any new drainage. Because of this severe early onset  capsular contracture, I personally would recommend this left breast implant be removed and a left total capsulectomy be performed. I would recommend NOT replacing a new implant at that time. Your Dr. may or may not place a small drainage tube depending on what is seen in the Operating Room. After adequate time has passed a breast implant could be replaced. All measures should be taken to reduce the risk of a recurrent capsular contracture of this left breast implant when it is ultimately replaced. This would involve replacing the new implant into a "partial submuscular plane" (not subglandular plane) through an incision at the inframmamary fold while utilizing the complete "no touch" technique of implant placement. You may also want to talk to your Dr. about  considering placing a textured implant on this side and/or possibly placing an acellular dermal matrix graft as well. I encourage patience with this process and I wish you the best of luck!

Amit Gupta, MD - Account Suspended · Answer

Good Evening and thank you for your question, Management capsular Contracture is one of the most difficult aspects of plastic surgery, your plastic surgeon is absolutely correct in suggesting capsulectomy for the capsular contracture management and I will suggest that you also discuss with him if we can do PRP within the capsule and that has been seen to improve the results a little bit.Best Regards, Dr Amit Gupta