I am assuming that you had no capsular contracture on your left side and that all went well with this particular breast. You state that you had repeat surgery in November 2016 and had new "implants" and "drains", did you have one-sided or two-sided surgery?

Let's assume it was one-sided for the purpose of discussion. Early capsular contracture can happen and doesn't mean the physician did anything wrong. I have had good luck with trying a new implant and using ADM at the same time. Although never a guarantee, it has solved many of my most difficult capsular contracture problems in patients with repeat issues. Certainly bring up the discussion with your surgeon; many times this has solved the issue in my patients. Hope this helps.

Published on Jul 11, 2012

Thank you for your question. I'm sorry you're experiencing another capsular contracture. Removal of the implants and replacement at later date, 3 to 6 months postoperatively is a possible option. To avoid implant removal, I would recommend replacing of the implant, capsulectomy, creation of a neosubpectoral pocket, use of ADM, perioperative antibiotics, use of a Keller funnel for insertion, antibiotic and betadine pocket irrigation, postoperative drains and prophylactic singular or accolate. As far as textured implants are concerned, there is a lower incidence of capsular contracture in the submammary plane, but not a statistically significant difference in the subpectoral plane. If you are not having a problem with the other implant, I wouldn't change it. Please discuss all your options with your plastic surgeon prior to undergoing another procedure. Take care.

Published on Jul 11, 2012

I am sorry to hear what you have gone through.
Unfortunately, some patients do have recurrent CC.
ADM is a good option for recurrent capsular contracture - speak with your surgeon about this use.
I hope this helps.

Published on Jul 11, 2012

Tough problem that we do not have the answer to. Currently, we are using a lot of ADM. I am not sure a textured implant matters one way or the other. I would stick with a smooth-walled implant. Total capsulectomy, I believe, is the key - that is necessary to remove all of the bacterial biofilm and bacteria.

Published on Jul 11, 2012

Thank you for your question. Unfortunately, capsular contractures are one of the most difficult cases in all of plastic surgery. We still don’t really know why contractures occur, we just have theories. What we do know is if a patient has a contracture, there’s about a 75% chance of developing another contracture by simply replacing the implants. It wasn’t until recent years that Strattice came out on the market, which is an acellular dermal matrix, sewn on to the new implant, and the chest wall. By using Strattice, it lowers your chance of developing a capsular contracture to less than 0.08%. It’s an amazing product that is used regularly for patients that suffer with multiple contractures. Only the top specialists in the country use this technique and product, however, so it’s best to find a specialist in your area that offers Strattice and has worked well with it.

Published on Jul 11, 2012

One of the latest technologies available in Northeast Ohio is through a company called Full Circle Solutions. They have available the technology called Aspen. It is an innovation specifically designed to treat capsular contraction or contracture for women with intact implants.

The patented ultrasound technology is now available for non-operative treatment of patients is your exact situation. If you are contemplating surgery for your capsule contracture, you may be an excellent candidate for this treatment option, especially if your surgeon has verified that your implants are intact. This treatment works for saline or silicone gel implants. It has indication for irradiation and non-irradiated implant reconstructions, as well.

The 30-minute treatment involves dual head painless ultrasound delivery during the 10 sessions. You will be taught to wrap your chest after the tight capsule is loosened by ultrasound energy. 90% of patients feel some resolution of their restricted chest wall and tightness after the first treatment! Each session leads to more improvement over 3 weeks.

If you have recently had a capsulectomy, then you may be a candidate for treatment using the same Aspen technology, using 5 weekly sessions before your body forms another contracture.

Patients treated with Aspen technology have a very high patient satisfaction. Almost all of them have appearance and functional, as well as range of motion improvements. It is worth checking out!

Published on Jul 11, 2012

Unfortunatley, there isn't an answer for your question that is guaranteed to work. Recurrent capsular contracture is not common, but it does happen as you are now aware. When I see this in my patients, I feel it is important to change what I am doing in order to hopefully alter the reasons for why it is happening. As your surgeon suggested, switching to a textured implant may help, and adding ADM has been shown to help. ADM is fairly expensive, and new implants certainly aren't cheap either. Still, I would suggest trying something different with your next surgery. You might ask your surgeon if he performed a complete capsulectomy as opposed to a partial capsulectomy or a capsulotomy. If he/she did not, then I would suggest that this be done.

Published on Jul 11, 2012

I have been seeing much less capsular contracture in my patients. Those that do get it, I use a neo-pocket so it can start fresh instead of the old space, even though the implant has changed.

Published on Jul 11, 2012

Capsular contracture (CC) can be a very challenging problem to treat and one of the most vexing aspects of breast implant surgery for women and plastic surgeons. The current theory to explain CC occurrence is that a "biofilm" develops around the implant due to bacterial contamination, which leads to increased inflammation and scar tissue, which, in turn, makes the soft implant undesirably harder, possibly painful and leading to a visible deformity. There are techniques to lessen the occurrence such as minimizing contact with particulate matter during surgery and normal skin or breast bacteria, despite sterile surgical skin prep and preventative IV antibiotics, as well as antibiotic irrigation of the surgical "pocket". Use of an incision in the breast fold (rather than around the areola) and a "Keller Funnel" to help insert the implant have been shown to help reduce the incidence.

Once CC occurs, there are non-surgical options such as Singulair, but definitive treatment often does require reoperation, at which time implant replacement along with at least partial removal of the capsule as well as placing the implant in a fresh tissue plane, if possible, can be helpful. Despite all of this, CC can recur yet again as in your situation.

For recurrent CC, all of the above, plus the addition of acellular dermal matrix (ADM) material, may help minimize recurrence. Ultimately, the decision is up to you as to how bothersome the pain and/or deformity is. After several attempts, removal of implants without replacement, while not ideal and seemingly extreme, is an option that is certain to prevent CC. Fat grafting is a safe and increasingly common alternative to help restore some breast fullness if implants are no longer desired.

Published on Jul 11, 2012

Sorry to hear about your dilemma! Was your surgery done through an inframammary incision? Was your revision surgery done through an inframammary incision? If the answer was yes to either question, then your risk for CC and recurrent CC was much higher than necessary. Additionally, was a total capsulectomy performed? If so, was it all in one piece? Not that I expect you to know those answers, but it makes a big difference if all the capsule came out in one piece; this is what prevents re-contamination of the tissue pocket with bacteria, the almost certain cause of your problem. If all those measures were attempted, then the next step is using an ADM. Please stop the massage and the Singulair; they are worthless. The fact that your surgeon prescribed these measures makes me concerned about his expertise.

Published on Jul 11, 2012

You should consult your surgeon. Once you have capsular contracture, you are at a higher risk to get capsular contracture with future surgeries. You are correct, sometimes patients do have better results with a textured implant. If your surgeon has done all of your breast augmentations, he or she will better be able to give insight into your reoccurring issue. If he or she has not always been your surgeon, it would help for him or her to see the operative reports from your previous augmentations. There is no right answer across the board for all patients. Good luck.

Published on Jul 11, 2012