Implant revision: Utilizing the subfascial plane
I agree with some of the concepts below with a couple subtle differences. Firstly I do not like the idea of placing a second foreign body such as stratice, this only gives more immunopriveledged material for bacteria to propagate and is absorbed over time. My preference is to convert to a subfascial plane which not only offers true support that lasts but also is an extremely well vascularized structure. I do not like submuscular placement because of the animation(movement) and distortion that results not to mention the central flatness that appears unnatural.
All the best,
Rian A. Maercks M.D.
Capsular contracture and new implants
Capsular contracture remains the most common complication after breast augmentation. It is equally frustrating for the patient and the surgeon. Today, we have better knowledge about its formation. We believe that if forms as a result of a low grade contamination from the body of the breast or the surgical experience. The contamination causes a bio-film around the implant that is impenetrable with antibiotics. So the latest teaching and experience dictates the following
Change of pocket after contracture
Placement in a sub pectoral position
Capsulectomy and not capsulotomy to treat contracture
Meticulous no touch technique of insertion
Reasonable (small) choice of size for implants
Change of implant with any capsular contracture event
The last point is very important as if one believes in the bio-film theory, then placing the same implant back is is not logical.
Hope that helps and good luck.
The Dreaded Capsule, What to do?
Capsular contracture remains one of the most frustrating end points for women who have enjoyed the joy of having breast augmentation or reconstruction. The best solution is prevention! Vigorous early post operative message is imperative and must be instituted as early as the patients discomfort will allow. The genesis of capsular formation is very complex and full of a bunch of long confusing hard to pronounce words. Suffice it to say that a capsule is laying down of more protective connective tissue than we would like. We certainly see it with infections of the breast, bleeding or more bruising than normal(fibrosis) or in those who have had radiation treatment for cancer therapy. Capsulectomy is the surgical term for removing the envelope that surrounded your implant. Capsulotomy is the opening up of the area so implants have more room. One last thought is the use of external ultrasound and oral anti-allergy agents such as Singulair, and Accolate. Consult with your surgeon, IT IS NOT O.K. to believe there is nothing to do for it. A lot can be done to help you.
Capsular contracture dilemma
This sounds like you have had a rapid entry into the perplexing world of capsular contracture. I'm sure that as distressed as you may be, your surgeon is equally so. If you ask five surgeons make a recommendation, you'll probably receive five reasonable alternative treatments. There is one definite procedure that will work: remove your implants. This recommendation is rarely followed, since most patients are initially happy with their breast augmentation, and did not desire to return to their pre-augmentation appearance. All of the recommendations that I've read are reasonable, including seeking another opinion. In my 30 year experience, patients who have had multiple capsular contractures rarely escape this problem.
Treatment options with established capsular contracture
Capsular contracture is the Achilles' heel of Breast Augmentation. Strange and vexing thing is that capsular contracture usually occurs on one side and sparing the other. When in doubt, I believe that it is wise to seek another board certified Plastic Surgeon's advise. Without photos, no one can really speak to you regarding advisability of a breast lift. Consider these options:
1) new implant
2)submuscular reposition of your next implant
3)post op off label meds such as Singular as an adjunct
4)Strattice (this material on the short term seems to minimize early capsular contracture. It is expensive but probably not as much as repeat operations
There looks to be 6 Plastic surgeons there in Amarillo to choose from. Good luck
Pre Breast Implant Revision: Best Way to Treat Capsular Contracture?
Difficult situation as described by you. Best to obtain 3 second opinions from boarded PS's in your area. Since no photos were posted very hard to give definitive advise.
Without an exam it is difficult to say what would best accomplish your goals. Strattice may help with capsular contracture reconstruction.
Best Way to Treat Capsular Contracture
Best way to treat capsular contracture would be to remove the old implant and capsule, and to insert a new implant. Use of Strattice is not routinely necessary. You may consider a second opinion.
Best Way to Treat Capsular Contracture?
Capsular Contracture, the hard scarring seen with up to 15% of breast implants is seen MORE in cases where there was excess blood in the breast pocket (aggressive blunt dissection or post-operative bleeding), foreign bodies, or microbial contamination or later sub-clinical infection. Placement of implants over the muscle (aka "overs") is associated with a higher rate of capsular contracture most likely due to colonization from bacteria in the breasts ducts.
Once capsular contracture occurs, it tends to occur with increasing frequency with each operation. Conservative, nonsurgical measures to treat capsular contracture have been at best a hit or miss proposition. Releasing the hold of the scarring by putting cuts in it (CapsuloTOMY) is associated with a very high rate of recurrence. Removing of the whole scar (Total CapsulECTOMY) is associated with a high rate of complications. Removal of most of the scar tissue (Subtotal Capsulectomy) with placement of a NEW implant (one that may not have a bacterial film on it) in either a sub-muscular pocket (if it is not there already) OR in a new pocket UNDER the scar, if it was there already) has been the best way to lower the chances of new capsular contracture. Recently, increasing amount of information has ALSO supported the addition of Strattice to this operation to FURTHER reduce the odds of recurrence of capsular contracture.
Review this strategy to what you had done and decide what you should have done next.
Peter A Aldea, MD
Reaugmentation with Strattice
Recurrent capsular contracture after capsulectomy happens more frequently than we like. My treatment of choice for your problem is to do complete capsulectomy with submuscular conversion, placement of new implants, Strattice (large piece) and a drain. Can't comment on need for lift without pictures. The latest data on Strattice for capsular contracture is very low recurrence rates.