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Should a new breast implant have been replaced instead of utilizing the old one?

Q:

I had an exchange done in 2007 and had to have a capsulotomy (a procedure in which part of the "capsule" of scar tissue surrounding a breast implant is removed or the tissue altered or released in some way. The procedure is performed as a way of attempting to fix the most common complication of breast augmentation surgery -- capsular contracture). that was grade IV. I developed a seroma two weeks later, that my surgeon felt did not or should not have been drained.  3 1/2 years later, I still have pain and I still experience drainage from the nipple with capsule and depression under my nipple. The culture was negative;  should a new breast implant have been replaced instead of utilizing the old one, and could it be causing other capsular issues?

A:

The thinking about the causes and treatment of capsular contracture has evolved in recent years, so without second-guessing what was done in the past, here is how we would approach it today: Implant replacement, total capsulectomy (removal of the scar capsule), and possibly plane change i.e. from over to under muscle if possible. However, there is no single correct answer that applies in every case. An option especially useful for recurrent capsular contracture is the use of a material called acellular dermal matrix (ADM) such as Strattice.

Richard A. Baxter, M.D.
Mountlake Terrace, WA

A:

Thank you for your question.  I suggest that you seek consultation with a plastic surgeon who is certified by the American Board of Plastic Surgery and a member of the ASAPS.

The management of capsular contracture has changed significantly in the past year or 2.  Currently is recommended that the capsule be removed, and a new breast implant be inserted with the addition of a dermal substitute such as Strattice or AlloDerm.

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