Capsular contracture on both breasts using 425cc HP mentor memory gel dual plane. What's my next steps? (photo)

I already talked to my PS about capsulectomy but I read about CC and doctors recommend using a new pocket. I'm already under the muscle now and really don't want to change to overs. In my previous question with pics, it shows my breasts riding high& sagging b/c of CC. Plus I believe I gained weight so I have extra breast tissue now. What's my best options regarding changing implant brand and size? My doctor asked me to research more before deciding but have some advice.

Doctor Answers 8

Capsular contracture

I do not feel a new pocket is necessary but I would agree that you should use a new implant with capsulectomies.  Most likely you will require drains post surgery as well.  Best of luck to you


Orange County Plastic Surgeon
4.8 out of 5 stars 36 reviews

Treatment for Capsular Contraction...

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 attach link ( demonstrating a case utilizing acellular dermal matrix) helps.

Optimal Treatment of Capsular Contracture

Hello,

Capsular contracture is caused by chronic inflammation, almost always due bacterial biofilm contamination. This is one reason why periareolar incisions put patients at higher risk than inframammary incisions. Changing planes is an old, outdated concept that should be left in the plastic surgery history books.  There are two effective ways of treating capsular contracture: total en bloc capsulectomy with new implants or total/subtotal capsulectomy with the use of an acellular dermal matrix (ADM) like Strattice, also using new implants. Regardless of your current incision, either of these surgeries should be performed through an inframammary incision.

My preference is a total en bloc capsulectomy.  Although technically more challenging, if done precisely will eradicate any bacterial biofilm and prevent re-contamination of the implant pocket with bacteria.  It avoids the need for a very expensive ADM product, and avoids the absolute need for a drain, which along with being inconvenient, can cause recontamination of the implant pocket with bacteria.

Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 79 reviews

Capsular contracture

Leave implants under muscle but use an ADM (acellular dermal matrix) like Alloderm or Strattice. This will reduce but not eliminate recurrent capsular contracture for which you are at high risk.

Richard Chaffoo, MD, FACS
San Diego Plastic Surgeon
4.7 out of 5 stars 17 reviews

Capsular contracture on both breasts using 425cc HP mentor memory gel dual plane. What's my next steps?

Dear Allibbyxx
Based on what I see, I can share the following:

Changing planes and going above muscle might not be  best option as it seems your soft tissue thickness is low in the upper pole and the implant edge would be visible and rippling might be very noticeable long-term.
I don't think changing implant brand will significantly impact capsule formation but going to textured implants might be of benefit.
It is difficult to assess need for a lift purely based on photos because the quality and elasticity of your tissues need to be assessed as well. I think considering your age, you might be able to avoid a lift with dual plane lift and implant replacement and capsulectomy. You would not be as perky as you want but it would be compromise.

Look for an expereinced and properly trained plastic surgeon certified by the American Board of Plastic Suergy. See more than one consult and make a well informed decsion.

Afshin Parhiscar, MD
Bay Area Plastic Surgeon
4.9 out of 5 stars 49 reviews

Capsular Contracture

Thanks for your question -

Capsular contracture (especially early capsular contracture) is typically managed surgically.  At our East Bay practice we typically would recommend implant exchange and capsulectomy.  Including dermal matrix can further reduce the chance of recurrence.

In many cases, not replacing the implants may increase the chance of capsular contracture recurrence.

You may also need a mastopexy to really improve your breast appearance as some of your residual sag likely won't be helped by treating the capsular contracture.

I hope this helps!

Capsular contracture

If your implants are hard, and only an examination can answer that question, then you have CC and often nothing more than a simple capsulotomy is necessary to fix the problem. But your real problem from an aesthetic standpoint is significant ptosis or droop of the breast tissue. This is totally unrelated to the CC if it exists and would require a full lift to corect. 

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

Need a lift.

In my opinion, from the look of your photos, the more important part of the equation is that you need a breast lift because the breasts now are hanging off of implants that are in a sub muscular pocket higher than the breasts are. If you want to change implants, or mitigate the effects of firmness, the options are to make a new sub muscular pocket or excise the bottom of the pocket to the muscle and replace with piece of an ADM such as Strattice. It would be unusual, in my experience, to have bilateral symmetric capsular contracture. It may be that a simple release of muscle and the bottom of the pocket to allow the implant to drop would fix this along with a lift. Discuss this with your plastic surgeon. Good luck.

Marc J. Salzman, MD, FACS
Louisville Plastic Surgeon
4.7 out of 5 stars 44 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.