Does capsular contracture ever come back worse after revision?

Thank you for the thoughtful question. As you know, encapsulation can be quite frustrating for everyone involved. Based on your description, it sounds like you and your plastic surgeon are doing everything possible to help prevent recurrence; unfortunately, recurrence is still a possibility.  In my experience, utilizing steps such as sub muscular conversion, the use of acellular dermal matrix and fresh implants, the use of a no touch technique, the use of  peri operative antibiotics and postoperative anti-inflammatory/massage, the chances of success are quite high. I have had cases of recurrence of encapsulation but none ( that I know all)  that were worse than our starting point. Best wishes for an outcome that you will be pleased with.

Plastic surgeons know quite a lot today about what causes capsular contracture and how to treat it.  However, capsular contracture around foreign objects in the body, such as breast implants, artificial hips and pace makers, is not completely understood.Two possibilities occur to me.  One, that your capsular contractures are secondary to non-pathogenic bacteria in your implant pocket which may not be completely eliminated during your secondary breast augmentation procedure.  Another possibility that comes to mind is that your body's immune system is very strong and will form a thick capsule around any foreign body.  Either of these two possibilities can lead to a second and potentially worse capsule than you presently have.Statistically, if you have chosen one of the excellent Board Certified plastic surgeons in San Francisco, then you should have a great result without re-encapsulation. 

The most effective method of preventing recurrent capsular contracture is essentially what you are doing: Capsulectomy, implant replacement with a textured implant, and Strattice. Your chances of long term success are very high with this approach.