Recurrent Capsular Contracture and Uneven Nipples? (Photos)

I had a BA in 2008 (saline, under muscle). I quickly developed cc in left breast and finally had a revision with new surgeon in 2014 (silicone implants under muscle) and capsulectomy. I took singular for a month after surgery. The cc just came back in left breast and surgeon prescribed me singular (been taking for 2 months). I want to get it redone, any way to reduce risk of cc? I also want to fix left nipple (has always been asymmetrical). Can it be moved down & center to match right nipple?

Doctor Answers 13

Recurrent Capsular Contracture and Uneven Nipples?

I am sorry to hear about the complications you have experienced. Capsular contraction can be a very frustrating complication for both patients and 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.

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). Adjustment of the breast implant capsules and/or movement of the nipple/areola complexes may be necessary to improve overall breast and nipple/areola complex symmetry.
I hope this, and the attached link and video (demonstrating a case utilizing acellular dermal matrix) helps.  Best wishes for an outcome that you will be pleased with.

REcurrent capsular constracture

Thank you for your pictures and question.  Revision surgery is definitely possible for you to help even out the asymmetry you are experiencing.  First off your next surgeon should use an inframammary incision instead of periareolar to help prevent recurrence.  There are a lot of other really good suggestions posted below.  For more information make some complimentary consultation appointments with Board certified Plastic Surgeons who perform a lot of breast revision surgeries.  Best of luck to you

Milind K. Ambe, MD
Orange County Plastic Surgeon
4.7 out of 5 stars 31 reviews

Recurrent Capsular Contracture

This is a problem which is still not completely understood but advances are being made and there are many modalities to address it. 
Current thoughts are that bacteria which live on the skin and in the milk ducts of the breast come in contact with the implant and produce an inflammatory response. There is some thought that the infra areola approach may have a higher incidence of capsular contracture as it passes through the breast.Currently, removing the capsule using triple antibiotic irrigation and a no touch technique with devices like a Keller Funnel are impacting the incidence and recurrence of capsular contracture. In some instances material like cadaver dermis have been placed to help combat recurrence as well.Seek out a board certified plastic surgeon with significant experience in revisional breast surgery.Good luck and I hope this was helpful.

Robert W. Kessler, MD, FACS
Corona Del Mar Plastic Surgeon
4.9 out of 5 stars 121 reviews

Your problems can be fixed

Hello and thank you for your question. I am sorry to hear that you have suffered from recurrent capsular contractures.There are many strategies shown to help decrease the occurrence of capsular contracture.  There are factors that YOU control and others that YOUR SURGEON controls.  Here is the breakdown:
1) not using any nicotine products at all
2) choosing a board certified plastic surgeon
3)not having any procedures done within 6 months after your surgery that can seed bacteria to your implants (like dental work and other procedures)
4) Not having your nipples pierced
1) Inframammary crease incision to insert implants
2) Using a Keller funnel to insert your implants
3) Using a consistent operating room team
4) Performing surgery at a hospital or highly credentialed surgery center
5) Using triple antibiotics to irrigate your implants and also the breast pocket
6) Placing implants in the submuscular pocket
7) Placing nipple shields to decrease chances for bacterial contamination during your surgery

In your case, switching to textured implants may give you slightly added benefit. Also, using acellular dermal matrix in the setting of recurrent capsular contracture has been shown to decrease chances of recurrence. During your revision surgery, your surgeon can also even out your pockets to help alleviate your nipple asymmetry. Make sure to seek consultation with a board certified plastic surgeon with expertise in revision aesthetic breast surgery. I hope this helps and good luck!

Dr. Sean Kelishadi

Sean Kelishadi, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 21 reviews

Treatment of Capsular Contracture

Hello,You may stop the Singular; it has no clinical effect on the treatment or prevention of cc. Unfortunately, you primary and revision surgeries have been performed through a periareolar incision.  This has placed you at the highest risk for cc and recurrent cc.  You should visit a few ABPS certified/ASAPS member surgeons that specialize in revision breast surgery.  You will need a total en bloc capsulectomy through an inframammary incision. Alternatively, a subtotal/total capsulectomy through an inframammary incision with the use of an ADM like Strattice may also be considered. Your nipple position asymmetry is due to your implant asymmetry, and will likely correct after proper treatment of your implants.

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 78 reviews

Recurrent Capsular Contracture and Uneven Nipples?

I'm sorry to hear about your recurrent capsular contracture. Capsular contracture is a frustrating complication for patients and their surgeons.
An initial procedure to address a capsular contracture is typically capsulectomy and replacing implants in a submuscular pockets. Surgical treatment of a second recurrence should consider adding ADM (acellular dermal matrix). The ADM helps prevent they contracture from recurring.
Consider multiple consultations with board-certified plastic surgeons in your area.


Thank you for the photos and question and the simple answer is YES.  So go on some complimentary consultations with experts in your are area and be evaluated.
Dr Corbin

Frederic H. Corbin, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 58 reviews

Recurrent capsular contracture

hi and thank you for the question. Capsular contracture can be very frustrating both for patients and surgeons. In your situation, Singulair will not be enough to fix the problem. Ultimately you will have to have the implant removed as well as the capsule.  A few things that I might suggest.  First, you can use a graft material during the procedure which can cut down on the risk of a future contracture. The second thing you can consider  is using a form stable shaped implant. These are the implants that people commonly referred to as gummy bear implants. There is some evidence that these shaped, textured devices are associated with a lower contracture rate. Finally,  you could consider starting Singulair early after surgery to potentially  encourage the development of a thin, soft capsule during the early healing process.
The nipple position can be a more challenging issue. Until your contracture is released it's hard for a surgeon to know exactly where your nipples are going to sit on the breast mound. Yes there are some things we can do to influence the final position.  My suggestion would be to see some of the busier breast specialist in orange county and see what kind of treatment plans they offer. Go with the surgeon you feel most comfortable with. Good luck to you.
Dr. West

Justin West, MD
Newport Beach Plastic Surgeon
4.9 out of 5 stars 22 reviews

Recurrent capsular contracture

Hi and thanks for your question. I'm sorry you're having this problem. The best solution is for removal of the capsule (capsule tony) and the placement of ADM (acellular dermal matrix). This significantly reduces your risk of recurrent capsular contracture compared with just capsulectomy according to several published reports in the medical literature. This is my experience after 30 plus years performing aesthetic plastic surgery including revision breast surgery. Good luck!
Best Wishes
Richard Chaffoo,MD,FACS,FICSTriple Board Certified Plastic Surgeon

Richard Chaffoo, MD, FACS
San Diego Plastic Surgeon
4.7 out of 5 stars 16 reviews

Capsular contracture

your capsular contracture may need to have an acellular dermal matrix placed to reduce the chances of another one developing. Also if you are a smoker, you increase your chances of developing another one.

Susan Kaweski, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 4 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.