Capsular Contracture for the Second Time. Any suggestions?

Hello. I had a bilateral breast augmentation in 2001 w/round silicone implants over the muscle (340cc), and I developed capsular contracture in 2008. I had a revision breast augmentation in 2009 w/round silicone gels again, also over the muscle, with 520ccs. I have CC again and I have been on Singulair for 6 months w/worsening symptoms. I know that switching to under the muscle w/new implants may decrease my incidence of recurrence, would anything else help decrease risk of recurrence?

Doctor Answers 5

See your surgeon

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You should make an appointment with your plastic surgeon for an in person examination as the symptoms you are describing could indicate a number of things. More pictures would be helpful, but having your doctor examine you and prescribe further treatment is probably necessary.
Good luck!    

Recurrent capsular contracture

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In cases such as yours, moving the implant to a new location under the muscle and using an aggressively textured silicone gel implant will certainly help the situation. If moving the implant under the muscle is not an option for you, then I've had success with complete removal of the capsule and suturing in a very large piece of Strattice to cover the top of the capsule which will touch the top of the breast. Then after surgery, I would add accolate and vitamin E beginning two weeks postoperatively. I hope this is helpful. Good luck.

Treatment for Capsular Contracture

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Massage and Singular are ineffective in the treatment or prevention of capsular contracture. This is a disease caused by chronic inflammation, almost always due to bacterial biofilm.

Any further surgery should be through an inframammary incision.  A total, en bloc capsulectomy needs to be performed to completely remove the entire capsule and implant in one piece. If you choose to remain above the muscle, you should choose textured implants, otherwise you should switch to subpectoral placement, where you can choose either smooth or textured. 

In addition to the above surgical recommendation, the use of biologic material known as an ADM has been shown to minimize recurrence too. This choice however, increases your costs significantly.

Best of luck!

Recurrent Capsular Contracture

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I am sorry to hear about your situation. Placing the implant under the muscle would have been the way to go after the first episode of capsular contracture. I really do not think you have a "disease" in anyway but just need to find yourself a board certified plastic surgeon who does a lot of breast augs. If not willing to have a third surgery you could try Accolate and breast massage for a while but it can take a year for that plan to pan out. I recommend you have a smooth silicone implant placed under the muscle and go about 50cc smaller. Best wishes

Joshua B. Hyman, MD
New York Plastic Surgeon

Capsular Contracture for the Second Time. Any suggestions?

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I am sorry to hear about the complications you have experienced. Capsular contraction can be a very frustrating complication for both patients and surgeons. 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, and the use of acellular dermal matrix. Into native
In regards to the success of the revisionary breast surgery, careful selection of your plastic surgeon will be the most important decision you make. I would suggest starting with the American Society of Plastic Surgery and/or the Aesthetic Society of Plastic Surgery to obtain a list of well experienced board-certified plastic surgeons.
Then, I would suggest you visit a few surgeons whose practices concentrate on aesthetic surgery.
***Ask to see lots of examples of their work and preferably speak/see patients who have had similar procedures done.
Be very careful with your decision-making. You will find, while doing your due diligence, that there are many different “specialties” who will offer their services to you; again, I strongly recommend you concentrate on surgeons certified by the American Board of Plastic Surgery.
I hope this, and the attached link/video, helps.

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.