Will capsular contracture happen to me again if I use a smaller implant?

Capsular contracture is a frustrating part of breast surgery
that can occur in a small percentage of patients. The reasons for capsular
contracture can vary. However, a few major themes are present and often
capsular contracture can be due to multiple factors. A common feature seen is
capsular contracture is the presence of a biofilm which is a small amount of
bacteria that can collect on the surface of the implant. The body tries to
clear the bacteria; however, it is unable to clear it due to the presence of a
foreign body (the breast implant). The result is an inflammatory reaction that
occurs which causes the body to tighten and potentially thicken the scar tissue
around the implant tightening the breast and creating a hardened appearance or
a firmer feel to the implant. A solution to this is generally to remove the biofilm,
which entails removing the implant and replacing it with a new implant and
removing the old capsule and washing the pocket out with antibiotic washes.I also frequently use an acellular dermal matrix called Strattice,
which can help to reduce the risk of recurrent capsular contracture. One of the
causes of capsular contracture can include trauma to the breasts particularly
when there is the presence of blood in the breast pocket, which can also
trigger more inflammation of the body. Size of implants does not have a major impact on capsular
contracture rates. Some studies have shown that larger implants are actually
somewhat lower risk for capsular contracture. However, I do not feel that
implant size should be taken as a significant consideration when dealing with
capsular contracture. Breast implant size should be appropriate to the base of
the patient’s body dimensions. One major factor specific to capsular
contracture is location of the implant placement. If the implant is placed
above the muscle, the patient could be at higher risk for capsular contracture
whereas if the implant is placed under the pectoralis major muscle the risk is
lower. Likewise, textured implants can reduce the risk of capsular contracture
particularly when the implant is in the subglandular (over the muscle)
position. If you have had an issue with prior capsular contractures
and are seeking treatment of this, I would make sure that you are working with
an experienced Board Certified Plastic Surgeon and you should consider complete
capsulectomy, implant exchange and possibly the use of an acellular dermal
matrix to lower your risk of problems in the future. Best of luck!

Thank you for your question.  Because you have had repeated capsules, you are at high risk for recurrence.  I have found that the use of smaller implants may help, but Strattice ADM (acellular dermal matrix) has been nearly miraculous for my patients with a tendency toward recurrent capsules.  It is important that you replace your existing implants with new implants, have a capsulectomy peformed, and although costly, seriously consider placement of Strattice ADM.  It works extremely well in preventing recurrence of capsular contracture.  You didn't mention if your implants were subglandular or submuscular but submuscular placement is optimal for reducing the risk of capsular contracture.  I would recommend seeing a few board certified plastic surgeons to discuss your options in more detail.  Best of luck to you. 

Plastic surgeons still don't have a good handle on why some patients develop capsules while others do not.  Switching to a smaller implant combined with removal of the old capsule may solve the problem, maybe not.  Unfortunately there are no guarantee that a disuse won't recur once it has happened.  Can be very frustrating.  I'm not a huge fan of acellular dermal matrix.  At that point, it becomes very costly and maybe removal of implants altogether is something to consider otherwise you could be dealing with the problem for years to come.

I am so sorry to hear about your capsular contracture travails. Sadly, putting in a smaller implant is no guarantee that CC won't occur again. However, changing the placement of the implant may help. Schedule an appointment to speak about your options with your surgeon. Best, Dr. Nazarian

1.It does seem that you have an issue with
forming encapsulation. Since it has
already happened twice to you, it is very likely to happen again. It is possible to have Alloderm placed at the
time of your revision breast surgery.
There has been some evidence that shows this may decrease the incidence
of encapsulation. You mentioned going
from 360 to 250: if that would cause sag or deflation. It may very well have a deflated look. It will not make a difference if you use a
different skin incision. The capsular
contracture is something that is happening due to your body’s reaction to the
breast implant. 

Sorry to hear that you are having a difficult time with capsular contracture. Unfortunately this is a possibility with breast augmentation. Typically capsular contracture needing a revision can result in needing future operations related to capsular contracture as you are experiencing. Smaller implants will not necessarily decrease the risk of capsular contracture. HOWEVER, depending upon where the implant was placed , either under or above the muscle, the operation to revise should address completely removing at least the anterior capsule, and then placing the implant in a new location, submuscular if initially subglandular or subglandular if initially submuscular. Also, the use of certain artificial biologic dermal substitiutes such as Alloderm, or sttratice may decrease the chance of developing another capsular contracture perhaps even with a bit of fat grafting. Most revision procedures should be performed with an incision under the breast because it gives the best exposure to adequately perform all the steps needed during the operation. I recommend you talk to your plastic surgeon about your particular case, and perhaps seek a second or third opinion with a board certified plastic surgeon who also performs many revision breast augmentations. Revision procedures can be somewhat difficult, and good results can certainly be achieved  in experienced hands. Good luck. Best wishes!regards,Dr. Ravi Somayazula

Thank you for the question and capsular contracture can recur no matter what sized implant is used.  That said the use of an ADM has prevented the recurrence of capsular contracture in 100% of the patients that I have used it on.Dr. Corbin

Reducing the size of your implant will not improve your odds for developing capsular contracture again. Unfortunately, the recurrence rate is for capsular contracture is over 20% after revision breast augmentation. However, you do have options to improve your chances for success after revision surgery, including 2 stage surgery or single stage surgery with the use of acellular dermal matrix or ADM. Thank you for sharing your question and concerns. Best wishes.Dr. Gregory Park

Sorry to hear you're having this problem. We always hope for perfection, but sometimes things don't heal the way we expect. The two best options now are either take out the implants and scar tissue and redo the procedure after 6 months or redo the problem side by removing all the scar tissue, placing ADM and using a new implant. Simply going smaller will not be helpful.

Dear Ms. Emwillamss.Thank you for your questions.Sorry to hear of your challenges.Capsular contracture is troublesome challenge and difficult but not impossible to treat.Principals of treatment include but not limited to:1) removing implant and replacing with new implant (Biofilm concept) using skin barriers and "no touch technique" while inserting implant2) removing all old capsule (total capsulectomy)3)sub muscular placement4)use of textured implant5)access incision: inframammary (breast crease)6) pre and post surgical antibiotics 7) use of a "acellular dermal matrix"I recommend that you make several consultative appointments with Plastic Surgeons who are experienced and Certified by the American Board of Plastic Surgery. In addition ideally they are members of the American Society for Aesthetic Plastic Surgery (denoting by membership as having met additional criteria and a focus on Cosmetic Plastic Surgery).I wish you my best and success,R. A. Hardesty, MD, FACSDiplomate and Certified by the Am. Bd. of Plastic Surgerywwwimagineplasticsurgery.com4646 Brockton AveRiverside, Ca 92506(951) 686-7600