BIG Help Needed with Capsular contracture

[22PT]

I am wondering what your protocol is for someone who has capsular contracture. A little hx on my case: I had saline implants 8 years ago and ~ 2 years ago one had a slow leak at the valve and I had to undergo surgery. I decided to go with silicone and go up 25 or 50cc Bilaterally. I had capsular contraction on the L after several months and massage techniques did not work therefore, my plastic surgeon did a capsulotomy. After about 3 months the pain was intense, I had a lot of bruising and I believe a hematoma and there wasn't any amount of massage that was going to allow for softening or dropping of the L breast with the CC that I had. I had to recommend a capsulectomy to the plastic surgeon and he completed the surgery. I am 3 months post op and I cont to have a firm L breast and there appears to be CC starting again. I am wondering what can I do to be the most aggressive with this situation. I have undergone way too many surgeries for this situation and I want to be as aggressive as I can. I have heard of using ultrasound, using bands etc..... What would you recommend if I were your patient? I am a PT and I have my own practice with an ultrasound machine so I could use that if need be. With your research and your clinical expertise on this subject what would you recommend??
Thanks so much for your time! 22PT

[sgwallachmd]

Which pocket were the implants placed in. Under the muscle, over the muscle? What post-op care was given? Massage vs no massage. Some surgeons have been recommending accolate( I am not one...however, with cases of cc it may be a suggestion). Some patients for unknown reasons keep getting CC.

[22PT]

Which pocket were the implants placed in. Under the muscle, over the muscle? What post-op care was given? Massage vs no massage. Some surgeons have been recommending accolate( I am not one...however, with cases of cc it may be a suggestion). Some patients for unknown reasons keep getting CC.

The implants are under the muscle. There wasn't any post-op care other then my plastic surgeon telling me to massage after 1 month post op and no sooner. Other than that there hasn't been any post op care. About 1 1/2 months ago I felt as though I could feel my pectoral muscle on the left start to contract and not release (question CC) so I asked if I could be placed on a muscle relaxer. I have been on this for about 9 days and I started to use an ace wrap to see if that would help the breast implant to drop and perhaps become less firm. I am sort of out on my own without much guidance unfortunately from my plastic surgeon. What would you recommend to one of your patients? There must be something that plastic surgeon recommend to their patients isn't there?? What are your thoughts regarding ultrasound, the compression garmets, ace bandages.... Thanks!

[sgwallachmd]

I only recommend massage. Muscle relaxers only help during the early post-op period. I don't usually prescribe them. You probably shoudldbe examined. If you feel that your doctor is not really there for you, then it is time to find a new one!

[22PT]

Originally Posted by sgwallachmd

I only recommend massage. Muscle relaxers only help during the early post-op period. I don't usually prescribe them. You probably shoudldbe examined. If you feel that your doctor is not really there for you, then it is time to find a new one!

I assume that you must have come across women who have had CC. How long do you recommend massage before you realize that it just isn't going to be enough? Is there a certain technique that you recommend and how often?? Please... any advice is helpful! Thanks! 22PT

[sgwallachmd]

I only recommedn massage during the first few post-op weeks and then once or twice a day after that. It usually is an exercise that pushes the breast toward ewach quadrant for 15 secs at a time. This won't help you weeks after surgery if you did not start early after surgery.

[22PT]

So if I am 4 months post op and I continue with massage can the CC decrease and potentially go away or what I have is what I will have? What do you do for your patients that end up with CC? Just Massage? I would like to think that there is something more aggressive before capsulectomy. Have you heard of injections of corticosteriods? I have no idea if this would work or not but I would like to think that surgery is the only way out. This is my 2 surgery in the last 7 months on this side for CC and I was told that the scar tissue is going to be a little tougher to break up with each surgery. Any thoughts?

[sgwallachmd]

I don't think massage will help at this point. I never heard of injecting steroids. Also, some people are more prone to CC and this can not be predicted..

[22PT]

So with all of your patients that have CC their only choice is to have surgery?

[sgwallachmd]

At this point, I would usually say yes.

[22PT]

I was just wondering if there is a difference between scar tissue and CC. My plastic surgeon keeps telling me that since I have had a couple of surgeries in a short period of time that there is going to be more scar tissue causing a slower healing process. Do you agree that this can be the case? He states that there is more scar tissue that needs to be massaged to allow the implant to drop and settle. It is the beginning of the 5th month. I think that the implant has dropped some in the last month or so and perhaps is getting a little softer but is not completely soft by any means. Do you agree with these statements and is it a potential that things will soften with massaging of the scar tissue?? I could send you a photo too if that would help you decide.

[sgwallachmd]

The breast usually come into their own, so to speak, after a few months. By 5 months they are probably where they are going to be.

[22PT]

Thank you so much for your patience while I ask all these questions. I am sure that it is hard to answer some of them without having me right there to evaluate. I took your advice though and went for a second opinion today and ABSOLUTELY LOVED the new plastic surgeon. I hate to think or say anything bad about the other plastic surgeon but this one really took the time to meet with me, took out a tape measure and described exactly what she thought she be done to rectify the situation B'ly! I am really nervous about going in for yet another surgery!!! What is your opinion on patients that you have had to complete a second revision due to CC?? Is it most likely going to happen again or should I give it another shot? Is there anything that I can do to decrease the chances of CC happening again? I HATE to give up my implants and the look that they provide me with (just proportionate) but at the same time I am not wealthy and can't keep having surgery after surgery. What would do you think?

[sgwallachmd]

There is a chance that it could happen again.