Rate of Capsular Contracture Recurrence?

Question

I started to develop cc at 8 months post op. I'm 10 months post op and it is not getting any better. What is the percentage of cc recurrence after having surgery to have the capsule removed? I have smooth silicone under. I read that saline has a lower rate of cc. Should I switch my implants to saline or it does not matter? I am really scared of having another surgery and having cc again.

Lewis Albert Andres, MD · Answer

Hello! Thank you for your question!  Recurrent capsular contracture is a very difficult problem. Assuming you tried conservative measures in the past - implant massage and may add the medication Singulair and Vitamin E.  If these fail, surgical correction may be necessary. It is a matter of surgeon preference as well as what is seen during your procedure that will determine whether or not a complete capsulectomy is performed. If significant capsule formation is seen intraoperatively, a full capule removal may be warranted with a drain in order to completely remove all of the tissue and allow better adherence of your breast back to its normal anatomic position down on your chest wall. Irrigating with certain medications may also be if benefit. Some other things that may have been tried include changing the position of your implant, addition of a dermal matrix, or consideration for the the shaped, textured, anatomical gel implants.  Without knowing your issues and without an examination, it is difficult to tell you what may be the best thing for you. I tend to favor performing capsulectomies in order to create a fresh pocket, reshape the pocket, allow better shape and adherence of the overlying breast. I would discuss your issues with your plastic surgeon who will assist you in determining the right modality for you.  At a 3rd recurrence, it may continue to occur despite all of these modalities and consideration for explantation or living with the contracture are options. Hope that this helps! Best wishes!

Jed H. Horowitz, MD, FACS · Answer

Capsular contracture may recur regardless of surgeries being performed at this time and may require additional surgeries. There is as much as a 40% chance that additional surgery will be needed following this operation. 
Nicotine users, such as smokers, have up to a 30 times increased #risk of capsular contracture. The #reason capsular contraction happen is unclear. It's possibly caused by microscopic bacteria on the implant, a   collection of blood after surgery or perhaps it is a tendency for some women to form scar tissue. What we do know is that is cases reported have decreased from 25% to  5-10% or less. 
One way to attempt the prevention of it is to follow your surgeon's post op instructions as recommended and ask questions of your surgeon when healing concerns arise.

Sacha Obaid, MD · Answer

I do not find that saline implants in my hands have a lower rate of capsular contracture than do silicone implants. I would recommend implant exchange and creation of a new pocket for your implants. I will tell you that you are at increased risk for capsular contracture with this second operation unfortunately. Best of luck.

Kenneth Hughes, MD · Answer

If this is the first capsular contracture, total capsulectomy with implant exchange is reasonable. In recurrent capsular contracture, dermal matrices may be incorporated into the surgery to decrease recurrence. Find a plastic surgeon with ELITE credentials who performs hundreds of breast augmentations and breast augmentation revisions each year. Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results. Kenneth Hughes, MD Los Angeles, CA

Vincent N. Zubowicz, MD · Answer

Silicone and saline implants have similar rates of capsular contracture. The rate of capsular contracture in the patient who is experienced that phenomena in previously will be higher with any subsequent implant placement.

Justin West, MD · Answer

Hi and thank you for the question. The numbers vary quite a bit depending on what kind of implant is used, whether your implant is above or below the muscle, and what incision is used. Unfortunately, many patients who have one contracture go on to have another. For this reason it is important that your surgeon does everything possible to reduce your risk of another one. Best of luck to you.
Dr West

Pouria Moradi, MBBS, FRACS · Answer

Hi Bea

	For all the literature written about CC, it is amazing how little we still know about this phenomenon especially the incidence and recurrence rate following surgery.

	1) How confident are you that you have CC? At 10months this is very early. Has your surgeon examined you yet?

	2) The best available evidence suggests smooth implants have a higher CC rate than textured implants when you go above the muscle. When the pocket is under the muscle, irrespective of the texture of the implant, the rates of CC are the same. That is, going under the muscle protects against CC. The importance of this for you is that if you need another procedure, your surgeon can choose to remain subpectoral or create a neo-pectoral pocket. He/she should discuss that with you in more detail.

	3) No evidence that saline protects against CC. I would stick to silicone.

	4) Seeing as you don't have bilateral CC. I am hoping that this is an isolated event so an implant exchange with a textured implant, capsulectomy and neo-pectoral pocket formation would be the procedure of choice.

	5) You can also consider changing implants to polyurethane coated implants, which do have a lower reported incidence of CC.

	 

	I hope this helps and good luck.

Jeffrey Zwiren, MD · Answer

There are many things that can be done to reduce the incidence of capsular contracture. The oddity is that it is not unusual for this to occur on only one side. Suggested treatment would include a complete capsulectomy, no touch technique, irrigation with triple antibiotics, using a new implant and avoiding any surface contamination of the implant. After surgery massage of the implant can be beneficial.

Stephen Salerno, MBBS, FRACS · Answer

Hello

	Sorry to hear that you have capsular contraction so early post implant surgery. Capsular contraction is one of the multifactorial conditions that no one understands fully and we have many theories and are unsure which one is correct.  It is also unpredictable in its behaviour and occurs in all types of implants to a degree.  The more severe cases become symptomatic. The actual rate of recurrence of capsular contraction will be impossible to predict.

	All the best

	Stephen Salerno

Remus Repta, MD · Answer

Hello Bea15,

	Thank you for the question.  Capsule contracture is not a completely understood issue of breast augmentation.  We do know however that removing all of the capsule and replacing the implant decrease the chance of capsule contracture recurring.  Using acellular dermal matrix (human or animal skin) to form the pocket further reduces the chance of capsule contracture.  You will have to have a discussion with your plastic surgeon about what option is best for you.  The safest would likely be to remove the capsule, replace the implant with a new silicone breast implant, and adding some acellular dermal matrix.  Going to saline is not likely going to make a difference and in doing so would require replacing both implants.

	All the best,

	Dr. Remus Repta

Rate of Capsular Contracture Recurrence?

Answers (12)

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