What Do You Recommend for One Sided Recurring Capsular Contracture? Cohesive Gels?

Question

I have had my implants changed x3 in 6 yrs and most recently just had a capsulectomy on the right, with return of the capsule w/in 2 months. It is uncomfortable,hard,misshapen and ugly. What are my options?

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!

Gerald Minniti, MD, FACS · Answer

Hello,

	I am sorry you have had such a difficult and unpleasant experience with breast augmentation.  In reality, both Drs Pozner and Rand are correct.  Dr Rand has made the assumption that all avenues have been thoroughly taken to prevent recurrance.  Dr Pozner is delineating how aggressive a surgeon has to be to try to erradicate recurrance.  In as few words as possible, capsular contracture is almost always associated with bacteria, and the environment they create around the implant called biofilm. Sources of contamination are usually the skin, the old implant, or remnants of the old capsule still in your body. Additionally, people who have occult infections like urinary tract infections can 'seed' the implants in your body with bacteria in your bloodstream after the surgery.

	Every few years I have seen people like you come to my doorstep. If you have already had 4 surgeries (original plus 3 re-operations?), you have every right to call it quits; I usually tell people three strikes and you're out. However, if you are game for another surgery, you should be very thorough the next time, starting with possibly choosing another surgeon who is an expert in revision surgery.

	I hope you can find happiness quickly.  Best of luck.

Tom J. Pousti, MD · Answer

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.  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).  I hope this, and the attached link ( demonstrating a case utilizing acellular dermal matrix) helps.

Todd C. Case, MD · Answer

Recurrent capsular contracture can be difficult to remedy.  There are a number of things that can be tried, but nothing is for sure a sure thing.  You may always get recurrent capsular contracture even years later.  With that said, changing from a smooth implant to a textured surface implant, moving a subglandularly placed implant to a submuscular position and/or removing the implant and scar tissue capsule Round the implant and placing a new implant.  Both saline and silicone gel implants can get encapsulated.

Steven Wallach, MD · Answer

Multiple capsular contractures are difficult to deal with. Some would suggest removing the entire capsule and placing the implant in a new pocket along with strattice, and others would suggest removing the capsule and implants and waiting a few months and then trying again.

C. Andrew Salzberg, MD · Answer

Given that you have had recurrent capsular contracture, I would be inclined to perform complete capsulectomies, exchange your implants, and consider using an acellular dermal matrix product such as Alloderm or Strattice. These products have shown to reduce the rate of capsular contracture.

Jason Pozner, MD · Answer

I disagree with Dr. Rand's answer. I would like to get the full story on your previous procedures and medical history. Was a complete capsulectomy performed and a new implant placed? Was a drain used? Do you have a history of sinus, urinary tract or other infections that could have contributed to capsular contracture? For the last few years we have been treating capsular contracture with complete capsulectomy, new implant and sometimes new position and Strattice placement.the data is excellent with zero recurrences at this time.

Richard P. Rand, MD, FACS (retired) · Answer

If you have gone to excellent plastic surgeons and are having recurrent capsules in 2 months, your body is telling you that it doesn't want the implants. Hard as it may be to accept, you should consider just having them out. Nothing is known that will change this course.

What Do You Recommend for One Sided Recurring Capsular Contracture? Cohesive Gels?

Answers (8)

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