What Can Go Wrong with Silicone Completely Under the Muscle for Someone Who's Developed Capsular Contracture? (Photos)

After my first breast augmentation I developed capsular contracture. Then I had another surgery to correct it. I developed then a pos-op infection that required implant removal . Now, I just did another surgery :textured silicone 400cc and 425 ccs under the fascia. I have a lot rippling and my right breast(400ccs) looks bigger. I am considering doing ANOTHER surgery completely under the muscle. What can go wrong this time? I am VERY thin & almost no breast tissue left. :(

Doctor Answers 7

Revision Surgery for Silicone Implants

HI,The problem is that you have relatively large implants for your size and very thin tissues. Completely sub-muscular implants will leave you with a double bubble, where the implant sits higher on the chest wall and the breast droops off of it. A dermal sling such as strattice is useful in this case. The implant would then only be partially sub-muscular and the lower pole would be supported by the strattice. I would also switch to smooth round implants because the textured implants tend to have more rippling. Finally some careful fat injection in the subsutaneous tissues can help thicken them so that the rippling is less visible. Good luck.

All my best,

Daniel Medalie, MD

Beachwood Plastic Surgeon
4.9 out of 5 stars 35 reviews

Revising submuscular augmentation after multiple complications

At this point what you need is restoration of soft tissue coverage.  I have had great results .in situations like this with a special technique of fat and stem cell micrografting.  the secondary problem is that your implants are too low.  Are you sure you had subfascial placement because your breasts do not look like typical subfascial results. It looks more like a neosubpectoral or a capsulorrhaphy.  Looking at your pictures I would think that there is still virgin fascia that can be elevated to restore a more appropriate footprint to your breasts.  Unfortunately a physical exam is necessary to be more certain.  I have restored women with situations like yours by creating a new cold-subfascial placement and using lower profile implants.  The cold-subfascial technique uses the dissection itself to create shape (tear drop) and projection, not the implant shape which creates an unnatural appearance and pressure induced atrophy of the overlying tissues.  I hope this helps!  


All the best,


Rian A. Maercks M.D.

Rian A. Maercks, MD
Miami Physician
4.9 out of 5 stars 73 reviews

Revision breast augmentation.

There are multiple issues of concern regarding your breast augmentation. You have shown a prediliction for contracture, you have larger implants, and your breast tissue is very thin as evidenced by the rippling in the upper poles. A dual plane placement of the implants (upper two-thirds under the muscle and lower third under the breast) will give a natural position to the implants on your chest, and the muscle coverage will significantly improve the upper pole rippling. The addition of Strattice, which is a porcine dermal matrix, to cover the lower one-third of the implants will allow for improved soft tissue coverage in the lower pole, significantly lower the risk of recurrent capsular contracture, and provide long-term support of your larger implants.  

David Bogue, MD
Boca Raton Plastic Surgeon
5.0 out of 5 stars 25 reviews

Thin women and breast implants

Latina: I agree with Drs. Pozner and Baxter that textured implants and a completely submuscular plane are impractical for you because of the upper pole wrinkling.  If you were to consider a 3rd revision, Strattice would be very useful both for implant stabilization as well as protective against recurrent capsular contracture.  This type of a procedure always requires a drain for a few days.  On the subject of drains, did your surgeon use them on your last case?  The fact that your right breast appears larger may be due to the accumulation of a seroma, after capsulectomy.  Seromas are also more common with textured implants, but should be investigated because of the theorteical risks of infection and also the presence of fluid around an implant can, in very rare circumstances be associated with a rare tumor called ALCL.  Speak with your surgeon. 

Lavinia K. Chong, MD
Orange County Plastic Surgeon
4.8 out of 5 stars 58 reviews

Strattice for capsular contracture

I agree with Dr. Pozner's advice here. Total submuscular is a very difficult thing to do without tissue expansion as is done for breast reconstruction. Strattice acellular dermal matrix will add support and coverage and appears to be very helpful in reducing the risk of capsular contracture.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 52 reviews

Revionary Breast Surgery with Acellular Dermal Matrix

You have an understandably frustrating situation: contracture, then infection, then rippling.  In a situation like yours i usually recommend that patients opt for the procedure with the most predictable outcome.  The current gold standard procedure for your situation is to have your implants placed submuscularly with an acellular dermal matrix sling (or hammock) placed to hold the implant in place.  Your implants are too large to be completely covered by your pectoral muscle.  Your muscle will likely only cover the top half of your implant.  The ADM will support the bottom half of the implant preventing downward migration and thickening coverage to minimize visible rippling..  Further, ADM has a very low contracture rate, so your chance of recurrent contracture will be least if you use ADM.

The most common ADM's are Alloderm (human cadaver dermis), or Strattice (porcine dermis).

Your other option is to leave things as they are and not do any further surgery unless the rippling worsens or the contracture recurs.

Gilbert Lee, MD
San Diego Plastic Surgeon
4.8 out of 5 stars 22 reviews

Strattice with submuscular placement

The issue with complete submuscular placement is the difficulty in placing larger implants and the fact that they often ride very high. I think the best approach for you is submuscular placement of smooth silicone implants with Strattice for inferior (bottom) support and tissue coverage. The early data on Strattice shows little to no capsular recurrence and the submuscular placement will mostly elimnate the upper pole rippling.

Jason Pozner, MD
Boca Raton Plastic Surgeon
4.7 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.