I think there are studies that tend to suggest a minimally decreased risk of capsular contracture when textured implants are placed under the muscle. But it is not a big difference. However if you have had a capsular contracture you might want to try to get this small advantage. It is known that putting implants in through the areola does give a higher incidence of capsular contracture because of contact with and colonization by breast bacteria. So your approach through the inframammary fold will avoid this source of bacterial contact. With the use of antibacterial irrigation of the new pocket, and use of the Keller funnel to reduce bacterial contamination from sliding across the skin the risk of recurrence wil be further reduced. If you want to reduce the risk still further you might consider the use of acellular dermal matrix or Seri which have been shown to get in the way of contracture forces even in cases of recurrent capsular contracture. It does add more expense to use the biological materials but may be worth it in the long run if it avoids a second capsular contracture.
Either smooth or textured implants can yield a good result. The choice of implant is largely determined by the procedure performed for the capsule. If your surgeon performs a capsulotomy (release of the capsular contracture without capsule removal), then a smooth implant is probably preferable, since it will gradually descend to a more natural position after surgery. If your surgeon performs a capsulectomy (removal of all or most of the capsule), then a textured implant is probably preferable, since a smooth implant may bottom out (descend too far) in the absence of capsular support.
its really hard to encourage you to change a good breast simply because you want it larger. You are starting all over again with risks and contractures can now impact both breasts. If you were my patient, I would be recommending that you just focus on the contracted side. Yes, the IMF incision is better and staying under the muscle preferred. Textured implants have not been known to adhere like they are designed so its really hard to say if going textured round will make much of a difference. And removing the capsule or cleanly dissecting it off the underside of the muscle is nearly impossible so you're not really getting all of the bad capsule out and not eliminating the potential for bacteria retained in the old capsule. So in my opinion, just focus on your bad side and try to get it good so you won't potentially be looking at contractures on both sides.
Thank you for your question. I would recommend that you discuss smooth versus textured implants with your surgeon. It will have their on preference when treating capsular contracture. In my office, I typically use smooth implants for revision surgery.
I appreciate your question.
The best way to determine implant size is based on chest wall measurements that fit your body. Once we determine that we can choose the profile based on what you want or need to achieve.
Implants under the muscle, there is less risk of capsular contracture. Anatomic implants tend to give a more natural shape with more nipple projection.
The best way to assess and give true advice would be an in-person exam. Please see a board-certified plastic surgeon that specializes in aesthetic and restorative breast surgery.
Best of luck!
Board Certified Plastic Surgeon
Director-Beverly Hills Breast and Body Institute
Thanks for the question. Sorry to hear about your capsular contracture (CC). In my patients, I like to use textured implants as I believe there is less CC with this. I also use other techniques like capsulectomy/otomy and possibly even an ADM to decrease the risk of CC. Certainly finding a Board Certified Plastic Surgeon and working with one will be helpful to you. Submuscular position also lowers the rate of CC. Good luck to you,
I only use smooth saline and silicone implants. Do not recommend textured implants because of malposition risks.
I am 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 (I do not think that there is a difference with smooth versus textured implants as long as the breast implants are in the sub muscular position), and the use of acellular dermal matrix (especially for recurrence). 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, helps.
Best wishes for a successful surgery. In general, I would use smooth gel implants as they move in the breast pocket for a natural look. Breast massage is rcommended to keep the pockets open.