Lower pole laxity following capsulectomy - would a simple capsulorrhaphy be a solution to my current ptosis? (Photo)

I recommend explantation and mini lift. Using a circumareola incision, the implants are removed, your breast tissue is reshaped, elevated higher on the chest wall and more medial to increase your cleavage. At the same time, fat transfers can be performed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

You don't really appear any more bottomed out on the left than you do on the right. It just seems like the implant is too small. Strattice is an excellent, if not overly expensive, supporting material that can do what any other absorbable mesh can do. When I look at you, you started out before implants with significant soft tissue asymmetry, and the placement of implants alone and the subsequent capsular contracture didn't help. I would consider surgery on both breasts to achieve the best symmetry possible. Preparation would include measuring distances like nipple to fold, nipple to sternal notch, overall breast tissue volume, and areolar diameter. Based on those measurements, you would have a complex surgery that would both modify the internal implant pockets and the soft tissue envelopes as well, the later executed through breast lifting (breast lifts don't just lift a saggy breast, they control skin surface area as well). This may come as a shock and perhaps going a little overboard, but this is what's required. In the end your scars would be barely visible and your breast shape would be optimized.

An examination is needed to see if mesh would be helpful. Sometimes the excess lower skin needs to be removed with an inferior incision. Your surgeon can let you know what is best.

Significant capsular contraction is going to significantly distort the shape of your breast, including the position of the implant.
The capsule is in the sense creating the structure that determines the breast. it’s not representative of what your breast will look like without a capsular contraction.
It’s like having a tennis ball underneath your skin.
Removing the entire capsule is the correct treatment for significant capsular contractions.
When the surgeon does this the structural tissues that created the shape of the breast are completely eliminated and the pocket is made larger.
if you do this and downsize implants at the same time you’re going to have a mismatch between the pocket size and the implant size.
Closing the pocket becomes difficult, because there is no capsule immediately after a capsulectomy.
This is not an easy problem to fix.
usually with time and new capable form, and the results typically will settle in and look better with time.
It’s also possible that patients will reform the capsular contraction, depending on what the ideology of the capsular contraction was in the first place.
if the dissection for the primary augmentation did not maintain the integrity of the IMF or infra mammary fold then a bottomed out appearance is more likely.
Even if the implant was placed correctly during the first procedure, this type of outcome can happen when you remove a thick, tight capsule completely.
Sometimes correcting this needs to be done as a stage procedure.
It’s really important to understand time frames when making an assessment for what you’ve been through.
Given yourself plenty of time to see if the capsule returns or what implant or breast shape looks like with time is probably not a bad way to go.
Just like the breast shape, began to change with a thickening of your capsule after the first procedure the same thing will happen to some degree with the formation of a capsule around your new implant. If the capsule continues to thicken with Contractor, then you’ll get a similar deformity.
If the capsule forms without significant contraction, then it should improve your outcome to some degree without needing intervention.
I would hang tight for at least 6 to 12 months before jumping into second revision surgery.
Don’t get too frustrated with your provider.
These are not easy cases.When downsizing in conjunction with a full capsule ectomy, the breast is not going to look as nice as if you go the other way(adding a larger implant)
You can always go out and get a few in person second opinion consultations.
I appreciate you, including as many quality pictures as possible.
It would be helpful to understand if you had capsular contractions on both sides and if you had capsulectomies on both sides
You can’t really have a capsulorraphy until you formed a capsule.
It’s a bit of a complex situation to give you a quantity assessment and response to without access to complete information.
You probably need in person second opinions to get something useful.
Best,
Mats Hagstrom, MD