Best Revision Option for Aesthically Pleasing, Symmetrical & Lasting Results After a Grade 4 Capsular Contracture? (photo)

I'm 33 & had my augmentation at 21 (5 years after pregnancy & breast feeding) & am seeking a revision due to a grade 4 capsule in my left breast. I have seen 5 surgeons so far and am finding it difficult to make a decision about my best option for revision - removal & uplift, replacing under the muscle, conical implants & fat transfer have all been suggested. I have been told my skin is very thin and I have little breast tissue, my implants are 300cc silicone overs, many thanks for your help.

Doctor Answers 7

Best way to deal with advanced breast contractures

really depends on what YOU want.  If you're content to return to your pre-augment size, then an explant/lift is best.  If you still want an augmentation and want to minimize the risks for another contracture, are you willing to accept the effects of a submuscular augmentation?  And if you're wanting perky, the scars of a lift?   Having a thin skin coverage certainly points you towards gel implants and you could subsequently choose to have a textured anatomic implant placed over the muscle with it's own drawbacks.  Your surgeon should be able to give you these options and discuss the pros and cons and if they only offer one choice, you need to find another surgeon.  It is confusing but there is an answer that should be based on what you want.  Good luck!

Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews

Best Revision Option for Aesthetically Pleasing, Symmetrical & Lasting Results After a Grade 4 Capsular Contracture?

I recommend removal of the saline implants, removal of all capsular elements, and place a silicone implant under the muscle followed by Strattice to cover the lower portion of the implant. this will give you the best result and least possibility of a capsule recurring.

Thomas Guillot, MD
Baton Rouge Plastic Surgeon
4.7 out of 5 stars 12 reviews

Breast revision and implants

Just from your photos, it looks like you may be a good candidate for implant exchange and a lift. With little soft tissue coverage, under the muscle may be better.   You will get many different opinions from different doctors.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 28 reviews

Improvement of capsular contracture over the muscle

Thanks for your question. There is certainly no replacement for an in-person consultation and examination. In general I believe you would benefit from removal of your saline implants and probably part or all of the associated capsule (scar around the implant). I would then recommend lifting up the chest muscle so a partially under the muscle pocket can be created for better upper middle breast coverage. This would be followed by a full breast lift to allow the lifted breast tissue to better match the new breast implant. I hope this helps.

Dr. Edwards

Michael C. Edwards, MD, FACS
Las Vegas Plastic Surgeon
5.0 out of 5 stars 35 reviews

Best Revision Option for Aesthically Pleasing, Symmetrical & Lasting Results After a Grade 4 Capsular Contracture? (photo)

You have seen several plastic surgeons and have been given many option .There are two others to consider

1 Use of an adjustable saline implant to over expand the capsule and then  reduce the volume several months later

2 Remove the implants and do a lift.  Scarring can be kept to a  minimum by using a circum-areolar incision

Hilton Becker, MD
Boca Raton Plastic Surgeon
4.6 out of 5 stars 15 reviews

Strattice for capsular contracture revision

Capsular contracture revision in cases like yours appears to be can be challenge. While no one can give you specific advice without seeing you personally, there are some general guidelines. First is removal of the scar capsule and a new implant. That will unfortunately thin the tissues even more, so an acellular matrix graft such a Stratttice provides new reinforcement, support, and coverage. Think of it as an internal bra. This could easily be done along with placing the new implant under the muscle, because the muscle will cover only the upper part and not provide support or coverage from below. A lift may need to be done but might be best to wait and see.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 52 reviews

Best Revision Option

Thank you for your question and for the attached photos. The photos are very helpful, but pale in usefulness when compared to an in person examination. 

With the available info, I would suggest removing these implants and the capsules, and placing the implants under the muscle. You may wind up needing a lift, but with the capsule removals, adding the additional lift incisions may compromise the blood and nerve supply to the nipples and areoalas, so I would wait and do the lift if needed at a later date.My inclination would be to use round implants.

Best wishes.

Jourdan Gottlieb, MD
Seattle Plastic Surgeon
4.6 out of 5 stars 45 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.