Capsular contracture (sp?) - should I get smaller implants?

Question

I am thinking of doing a breast revision for scar tissue. I’m trying to decide between getting them removed with a lift, just cleaning out the pocket using the same implant and lift or choosing smaller implants and a lift. I’m terrified of getting the same issue or worse. Your thoughts? Currently I have 625cc I am 5’7 175 lbs. I am currently working out and hoping to lose at least 15 lbs possibly 25.

J. Timothy Katzen, MD, FACS · Answer

Thank you for your question about whether to opt for smaller implants. Your apprehension about experiencing the same or worse issues, specifically capsular contracture, is valid. Statistically, patients who have experienced capsular contracture are at a higher risk of encountering it again, even with new implants.

If this fear weighs heavily on you, I would recommend not having implants inserted again. You might want to consider having your current implants removed and undergoing a breast lift instead. However, if you feel strongly about having implants, then choosing a smaller size, preferably with an old silicone implant in a different pocket, could be a viable option.

After the surgery, I would suggest taking Singulair for at least three months. Good luck with your revision surgery.

Sincerely, Dr. Katzen

Vishnu Rumalla, MD · Answer

Thanks for your inquiry, cannot answer your question about downsizing of implants without a conversation about your size goals. In general, if you have developed encapsulation, it is best to change the implant at time of capsulectomy to reduce chance of recurrence.

Gerald Minniti, MD, FACS · Answer

If your fear is recurrent capsular contracture, then you need to identify root causes. One of them isn't one of them per se: implant size. CC can occur early (within 6 months from surgery) or later. Early reasons include the use of periareolar incisions, implant placement over the muscle, not irrigating with Betadine prior to implant placement, not using an implant deliver funnel, or poor wound healing. Late causes include bacteremia (bacteria in the blood stream from an infection or procedure not prophylaxed with antibiotics), or long term silicone gel implant rupture. Fixing CC should include the use of an inframammary incision, removing and discarding the implant, and removing as much of the scar capsule as possible. A new implant should be used and should be placed in the sub-pectoral position. A drain should also be used, and if so, antibiotics should be given until the drain is removed. Biologic material known as acellular dermal matrix can also be placed at the time of surgery.

Daniel Barrett, MD · Answer

Dear tashmommy,
breast revision surgery is the most difficult plastic surgery procedure performed. Botched breast surgery alters normal tissue planes and laxity, the ability of breasts to heal properly, and leaves scar tissue that dramatically affects the level of difficulty of the corrective surgery.Many patients come in to correct poor outcomes from their initial surgeries. The most common problems are due to implant malposition, bottoming out of the implant, poor scarring, and incorrect implant size.While the type of revision required will depend on the result of the previous surgery and the desired result of the patient, some revisions involve extensive pocket repair that may or may not need specialized external bras.If you are considering breast surgery revision, you should speak with a board certified plastic surgeon and have yourself properly assessed. Only after a thorough examination you will get more information and recommendations. Also, you have to make sure that your surgeon understands your breast augmentation goals.
 Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Connie Hiers, MD, FACS · Answer

The 625 cc implants are very large and heavy implants that have thinned and stretched your tissue. Yes, go smaller to have a better weight on your tissue and less risk of capsule formation.  If you can be lifted, it should hold better with less weight.

Capsular contracture (sp?) - should I get smaller implants?

Answers (5)

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