Have Had Encapsulation With Saline Implants, Than Again After Revision. What Are My Options?

I Had Saline Breast Implants 6 Years Ago.  I Had my Left Breast Implant Replaced Due to an Encapsulation.  Within 4 Months I Had an encapsulation again on the same left side. At that time I replaced both implants with silicone. Now 3 years later I believe I am experiencing encapsulation again on my left side. what are my options?

Answers (6)

Have Had Encapsulation With Saline Implants, Than Again After Revision. What Are My Options?

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. 

Breast Augmentation Complication, Capsular Contracture, Hardening of the Implants

You have several options for the treatment of your breast implants with capsular contracture. It helps to understand the problem first.

  • Capsular contracture or hardening of the implants has no clear cause or etiology. In other words, we are not sure exactly why it happens.
  • We do know that subclinical infection may play a role. Classic infections are associated with red, hot, swollen breast implants. Capsular contracture may involve infections that are low level and  harder to detect.
  • The placement of the implant beneath the muscle is one of the mainstays of treatment. If your implants are not beneath the muscle than your answer is this placement. You may need a lift, however  if you have extra skin.
  • Acellular substitutes are new and an option. They tend to be extremely expensive and cost prohibitive.
  • Complete capsulectomy and not partial capsulectomy has better success rates with this breast augmentation risk. Did your doctor remove all the scar tissue or just some of it?
  • Succes has been seen with implant removal and complete capsulectomy followed by a healing period with the implants completely removed. After a period of time - 6 months- they can be replaced. This makes sense if subclinical infection plays a role.

I recommend you get another opinion. It's always a good idea. Are they under the muscle? Did you get a complete capsulectomy and not cutting or partial removal?  If all this has been done than an option is removing them and all scar tissue.  Wait 6 months and then replace the implants. Hard choices I know!

Christopher Saunders, MD
Christopher Saunders, MD
Wilmington Plastic Surgeon
85 reviews

Capsule formation

Some patients develop capsular contractures more than others.   Recently surgeons have been using strattice while removing the implant capsule and exchanging the implant. This has been found in some studies to help.

Steven Wallach, MD
Steven Wallach, MD
New York Plastic Surgeon
30 reviews

Strattice for recurrent capsular contracture

When implants are replaced for capsular contracture, it is usual to place them in a new pocket so I will assume that if they were above the muscle then they are already under. The use of what is called "acellular dermla matrix" such as Strattice or Alloderm has been very helpful in my experience with recurrent capsules. Strictly speaking the "on-label" use is to replace the tissue that was removed with the capsulaectomy.

Recurring capsular contracture

The best we have done for capsular contracture is replacement in a new pocket, with recurrence rates near 50%. An allograft has been recommended 'off label' to reduce the recurrence rate but evidence so far is not conclusive. A very few will give up on implants altogether, and many more live with the firmness.

Best of luck, peterejohnsonmd.com

Multiple capsular contractures

Some folks just can't have implants and maybe you are one of those.  So one option is to have them out and be done with the frustration.  The other is to go into another pocket, preferrably below the muscle if you are currently above.  You didn't mention anything about that.  The last is experimental and would be to do a complete scar removal and add Alloderm or Strattice to the pocket as these dermal substitutes are anecdotally being felt to possibly decrease capsular contracture.

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.

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