Questions about Capsulorrhaphy; Can you have larger implants?

I will be needing Capsulorrhaphy, I am very naive about this procedure and worried. Greatly appreciate if you can help me to understand better. Thank you! Can you have larger implants? I am 390 and 360 submascular wanting to go up to 500, saline to silicone. Are the sutures enough to hold? Physical restrictions, lifting > 50 lbs at work, Is it true I have to wear a support bra 24/7 and for how long? where can I buy one? Do I have to wait for implants to drop and fluff like the 1st time?

Doctor Answers 6

Capsulorraphy and Larger Implants?

Presumably you have implant malposition or bottoming out and therefore are in need of a capsulorraphy (suture tightening of the capsule) to reposition your implants. While usually successful, there is always some risk of recurrence of the problem. Unfortunately if you want a larger (and heavier) implant, then the rate of recurrence will significantly increase. The risk of recurrence can be decreased by adding some soft tissue reinforcing material such as Strattice, but this significantly increases the complexity and cost of the surgery. 

Most surgeons would have you wear a bra 24/7 after a procedure such as this, and if your work requires lifting heaving weights you will need some weight restrictions for 6-8 weeks until everything is solidly healed. Having such a physical job will also increase your risk for recurrence of the problem. 

You may have to choose between size and successful repositioning.

If you increase the implant size, you will undoubtedly increase the weight of the implant.  I assume that you have an issue with the current position of the implants and are trying to reposition them using a capsulorrhaphy.

Anything that puts pressure on that repair will impact the success of the tightening procedure.  Hence, larger implants will work against the very thing you are trying to achieve with the capsulorrhaphy.

In a nutshell, a capsulorrhaphy is a procedure that sutures the implant pocket (capsule) to close off excess space and/or reposition the implant into either a higher, more lateral (if you have an unaboob), and more to the center (if your implants are sliding too far to the side).  Because most of the strength of your repair is comprised of the inherent strength of your capsule and tissues, and these tissues have proven to be too weak (or you wouldn't need this repair), success with a capsulorrhaphy is not 100%.  Adding an artificial material such as Strattice or Seri could improve that reality, but you're still dealing with a less than perfect environment for repair.

That said, reference the statement above regarding the weight of the implant putting pressure on the repair.  Therefore, you ultimately may have to choose between the final size of your implants and your desire to have them positioned in a more appealing place.

Regarding restrictions, you will definitely have lifting and exercise limitations, and bra use is almost certain to be a 24/7 deal.  You'll get specifics from the surgeon you select, and he or she should be very detailed in the do's and don'ts after this rather tricky surgery.  Be sure to thoroughly review all of these concerns with them during your consultation.

Lastly, you will likely experience a period of some swelling, but the position of the implants should be almost immediately visible when that fullness has resolved.  Typically, this is much less pronounced and resolves much sooner than with a primary breast augmentation.

Best of luck!

Predictors of success with capsulorrhaphy

A capsulorrhaphy is a stitching of the scar capsule that forms around implants. The success depends a lot on why the capsulorrhaphy is necessary. If the capsule has thinned out, then larger implants will put more stress and make the issue more likely to recur. It is not the sutures but the scar capsule itself that is responsible for the long term result. It is is thin then it doesn't matter whether the sutures are permanent, what size they are, or how skillfully placed. Reinforcement with internal bra materials such as Strattice or Galaflex can be helpful for thin capsules.All of this requires an in-person evaluation to sort out.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 45 reviews



This is a procedure to tighten the capsule which in turn repositions the implants. The presumption is the implants have dropped out. Performing this procedure and using bigger implants puts you at an even higher risk for the same problem to recur. 

Best of luck!

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

Questions about Capsulorrhaphy; Can you have larger implants?

We can't comment about your specific case without an exam or good photos, but capsulorrhaphy can easily support 500cc implants when properly done. We require the patients to wear a well fitting underwire bra 24/7 for 8 weeks and avoid any activity that causes heavy work for the pectoralis muscles during that same period. 

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 24 reviews

Questions about Capsulorrhaphy; Can you have larger implants?

I am sorry to hear about the problems you are having after breast augmentation surgery.  Good/specific advice would require in-person evaluation but capsulorraphy techniques can be very helpful when it comes to correction of implant displacement concerns. In my practice, I use a two layer permanent suture repair in the areas necessary to prevent implant  displacement issues. Sometimes, depending mainly on the patient's history and physical examination, I will also use additional supportive materials such as acellular dermal matrix or biosynthetic mesh.   

 In my practice,  the appropriate size/profile breast implant of breast implant is best determined using intraoperative sizers during surgery after careful communication with the patient prior to surgery.  In many cases, the use of larger breast implants is safely possible.

 Yes, careful restriction of postoperative activities is an important part of the process, and in my opinion, very important when it comes to prevention of recurrence of breast implant displacement.

Make sure that the plastic surgeon who does this procedure for you can demonstrate significant experience with this type of revisionary breast surgery. 

I hope this, and the attached link (dedicated to corrective surgery for bottoming out concerns), 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.