What is the Likelihood of Repeated Capsular Contracture with Implant Replacement and Position?

I developed Baker Grade IV capsular contracture within a year of getting silicone implants above my muscle. Years later my ps replaced them with saline and within a year or so I had Baker Grade IV again. A different ps now suggests that I undergo revision surgery to remove my scar tissue and implants then replace with saline but this time below my muscle. Given my history, isn't it more likely than not for me to develop capsular contracture even with a submuscular placement?

Doctor Answers 5

What is the Likelihood of Repeated Capsular Contracture with Implant Replacement and Position?

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 ( human, porcine, or bovine in origin).  I hope this, and the attached link ( demonstrating a case utilizing acellular dermal matrix) helps. 

San Diego Plastic Surgeon
5.0 out of 5 stars 1,503 reviews

Rate of recurrent capsular contracture

Your question is very complicated.  Capsular contracture is not always preventable.  It can occur due to an infection, radiation, hematoma or just the way and individual heals.  Capsular contracture can be minimized from the surgeon's side by placing the implant underneath the muscle. This may be a prudent way to go given that placing the implant above the muscle is known to have a higher rate of capsular contracture. Some surgeons advocate breast massage as away to keep an implant mobile in a capsular pocket. Its effects on capsular contracture are debatable and unknown. The rate of return depends on the reason the capsular contraction first occurred.  Also, if the capsule was removed, scored or partially removed is also important to know to make a reasonable assessment. Truly because of the complexity, you should consult with a board certified plastic surgeon who is comfortable with complicated revisions of the breast.

Raj S. Ambay, MD
Tampa Plastic Surgeon
4.3 out of 5 stars 35 reviews

What to do for repeat capsular contracture

Repeat capsular contracture may require a different implant algorithm that includes removal of the entire capsule and replacment of the breast implant.  There are available options for treatment, however. 

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
4.8 out of 5 stars 94 reviews

Repeated capsules

If you have had repeated capsules, it may be a good idea to try new implants, and place strattice inside as well. It is thought that the strattice may decrease the risk of capsule formation.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

What is the Likelihood of Repeated Capsular Contracture with Implant Replacement and Position?

Yes. The more you've had, the more likely that you will get another after surgery. Speak to your surgeon about using an ADM--acellular dermal matrix, such as strattice for any additional surgery.

This seems to have a significantly lower recurrence rate in terms of capsular contracture than the other techniques. It is pricey though, but not if you compare with repeated unsuccessful surgeries.

Thanks, and best wishes.

Jourdan Gottlieb, MD
Seattle Plastic Surgeon
4.6 out of 5 stars 45 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.