What should I expect for a breast revision after severe capsular contracture?

I have seen 10 plastic surgeons about revisional surgery on my breasts and have received many different answers. Some physicians state it's better under the muscle while others state that over the muscle is just fine. I've left feeling like I didn't get all the information I needed and that perhaps a regular breast augmentation would be much easier. Also, I'm reluctant about general anesthesia since I had a severe reaction in the past. I'm older and more cautious so I really want more detailed information about my procedure before making the final commitment. I'm so nervous because I feel that maybe I need more information than most.

The earliest 3 answers in this series address the concerns about capsular contracture quite well and little substantive information can be added here. I would recommend that you seek the consultation of a plastic surgeon certified by the American Board of Plastic Surgery. They have a website listing all the certified plastic surgeons. Members of the American Society of Aesthetic Plastic Surgery will all be board certified in plastic surgery and have demonstrated an interest and competence in cosmetic plastic surgery as well.

I will, however, address your question about anesthesia. Today in the U.S. anesthesia administered by a board certified anesthesiologist in a regulated/certified facility is very safe. You should receive a phone call from the anesthesiologist a week or so before surgery. At that time your medical history and anesthetic history will be reviewed in detail. Please mention any and all concerns and medical issues that you have including any and all medications that you take, even over-the-counter medications. That will help the anesthesiologist formulate an appropriate anesthetic plan for you. This may include preoperative testing and/or labs and a decision as to whether you would be better/safer as an in-patient with an overnight stay or whether your anesthesia can be safely managed in as an out-patient. Either way the anesthesiologist is dedicated to making the operative experience as safe and comfortable for as absolutely possible.

Alexander G. Nein MS, MD
Alexander G. Nein MS, MD
2400 Patterson StNashvilleTN37203US

Alexander G. Nein MS, MD

2400 Patterson Street, Suite 202, Nashville,
TN, 37203, US

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Your questions have been very well addressed by Drs. Gartside and Epstein. As a rule, capsule formation is lower with implants placed under the muscle. There is increasing work indicating that the addition of ADM (Acellular Dermal Matrix such as Alloderm, Stattice or Seri) between the lower edge of the muscle and the 5th rib covering the lower part of the implant reduces the incidence of capsule formation and lastly some work indicates that textured implants and saline implants have a lower incidence of capsule formation. There is a recent paper indicating that the use of low dose steroid irrigations through a fine catheter for 3 days after revisional surgery reduced the recurrence of capsule formation. It is still a contentious problem which is why there are still many opinions. There is no one best answer for everyone as Dr. Epstein has pointed out.

Peter P. Kay MD, FACS
Peter P. Kay MD, FACS
2355 N Wyatt DrTucsonAZ85712US

Peter P. Kay MD, FACS

2355 N. Wyatt Drive, Suite 111,Tucson, AZ,
85712, US

I would hope that after seeing 10 different plastic surgeons, you would have received enough information about the surgery, risks, pros and con. I would have a couple of recommendations, first, you will know when you are ready to proceed and until then try making a list of your goals and the pros of surgery and on the other side a list of the cons, risks and things that make you nervous. You might need to seek the help of a trusted friend, family member or family physician to go over this with you. Next, would be to pick the top two practices you are personally connected with the most and review the list with them. Seeking out more surgeons to see at this point may continue to confuse the situation. Be sure that the surgeons you did see are Board Certified Plastic Surgeons and are experienced with treating capsular contracture. Your family doctor may also help with recommendations.

Roberta L. Gartside MD
Roberta L. Gartside MD
1800 Town Center PkwyRestonVA20190US

Roberta L. Gartside MD

1800 Town Center Parkway, Suite 412, Reston,
VA, 22090, US

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I believe that the detailed information that you seek is impossible to obtain unless you are examined, in person, because there are so many variations of problems that need to be considered when dealing with capsular contracture. How big was your breast preop? What is the quality of the skin and soft tissue of the breast now? What is the likely condition of your breast after the implant and thick capsule are removed. Are your implants above or below your muscle now? What type of implants do you have now? Are you willing to consider exchanging your implants? And if so, for what type of implant? Are you willing to consider the use of an internal biological dressing (pig or cadaveric dermis) in the hopes of improving soft tissue coverage and/or decreasing the risk of recurrent contracture? Would you consider removing your implants and not replacing them? Will you need a breast lift? These are just a few of the details that are usually discussed when a patient presents with this problem. Being evaluated by a Board certified Plastic Surgeon that has experience with these types of problems is highly recommended.

Michael A. Epstein MD
Michael A. Epstein MD
1535 Lake Cook RdNorthbrookIL60062US

Michael A. Epstein MD

MAE Plastic Surgery,1535 Lake Cook Road,
Suite 211, Northbrook, IL, 60062, US

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