400cc, silicone, capsular contracture, sagging & large areolas, what procedures would you suggest? (Photos)

Hi RM,
I'm sorry to hear you're suffering from this! There are many things we, in the medical community, know about capsular contracture but there are aspects of the condition that remain unknown. To answer your question, you can indeed, suffer from capsular contracture again. Anecdotal evidence shows that those who have had it are more likely to have it again. Every surgeon and implant manufacturer will give you a different stat, but globally the incidence of capsular contracture is about 3-5% of patients who undergo breast implant surgery. Electing to go up in size or to a higher profile will lift the breast a bit, but if your goal is for the breasts to be considerably higher, you will need a mastopexy. The areolas can be reduced during a mastopexy procedure, so that could address both of your concerns.
I wish you the best of luck in your search for treatment!
- Dr. Nik

You have large areolas, ptosis, and asymmetry. My recommendation would be a vertical lift with the same or slightly smaller implants. I would not recommend a Benelli lift to reduce your areolas since this would possibly leave a hypertrophic scar around your areolas.

Dear rm007,
breast revision surgery is the most difficult plastic surgery procedure performed. Botched breast surgery alters normal tissue planes and laxity, the ability of breasts to heal properly, and leaves scar tissue that dramatically affects the level of difficulty of the corrective surgery.Many patients come in to correct poor outcomes from their initial surgeries. The most common problems are due to implant malposition, bottoming out of the implant, poor scarring, and incorrect implant size.While the type of revision required will depend on the result of the previous surgery and the desired result of the patient, some revisions involve extensive pocket repair that may or may not need specialized external bras.If you are considering breast surgery revision, you should speak with a board certified plastic surgeon and have yourself properly assessed. Only after a thorough examination you will get more information and recommendations. Also, you have to make sure that your surgeon understands your breast augmentation goals.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

The likelihood of having another contracture depends on the surgeon technique, sterile technique, implant irrigation, incision/access, and implant pocket location. I would recommend placing new implants and potentially removing the capsule. In addition, I would also recommend placing Galaflex to help support the implant and reduce the risk of capsular contracture (the data on that is preliminary). I would highly recommend finding a highly trained aesthetic plastic surgeon (preferably 6 years of dedicated plastic surgery residency and 1 year of aesthetic fellowship). Best of luck!

At this time, I recommend explantation and lift using The Bellesoma Method. The implants are removed, your breast tissue is reshaped creating upper pole fullness, elevated higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided, nipple sensation and the ability to breast feed are maintained if not injured during your previous surgery. Later, fat transfers can be performed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Dear Rm007,
It is always a possibility that another capsular contracture can happen. It would be helpful if you pinpoint what may have been the trigger. Did your surgeon use a Keller funnel to insert a silicone implant? Is it under the muscle? Did you avoid blood thinning medication pre and post-op? Did you give yourself adequate recovery time before becoming active again after surgery? Are you a smoker?
Regarding the shape and size of the implant, a larger implant will only contribute to the sag you elude to right now. High profile is just a different shape that gives you slightly less teardrop but doesn't "lift" the breast. Regarding an areola reduction, does a scar around your areola and the risks of additional surgery appeal to you more than the size of your areola? That's a choice.
Best wishes to you!

With a capsule, you need to go down to a smaller implants. A larger implant will just increase the risk of capsule formation. Going smaller, you also will need a lift. I would suggest placing the implants behind the muscle as well and taking Accolate around the time of surgery.

First, performing a total capsulectomy and replacing the implant still faces around a 15% chance of re-occurrence (However, a Google search may put this as high as 25%-70% but I have not seen these reoccurrence numbers in my practice).
An areola reduction would make the areolas smaller and yes, sometimes the scar may spread and the areola size increase.
A High Profile implant may give you more projection, but not affect the droopy appearance. A periareolar mastopexy (which includes an areoal reduction) would benefit you.