What is my best option for capsulular contracture corrective surgery?
I have been given 3 options for the correction 1. Remove the implant, clean and reinsert 2. Remove the implant and replace with a new one. 3. Remove both implants and replace but have been advised to put the implants over the muscle where they are currently behind. Questions are, since this is the second time I will have to be opened up again is it necessary to go over the muscle because the pocket may be contaminated? I have heard the results aren't as good, is this true?
Treatment of capsular contracture typically involves replacing the implant, removing the scar capsule, and possibly a plane change (either switching from under to over or vice versa. There is another option that has been effective in my practice, which is the use of a material called "acellular dermal matrix" such as Strattice. This seems to be able to prevent recurrence of the contracture, while adding support and coverage which can be compromised when the scar capsule is removed.
Certainly there can be multiple ways to treat capsular contracture. A change in plane or pocket is how I approach it as well. You mention clean and reinsert. If you had an infection in the past that is an entirely different matter. That I handle differently and usually will remove the devices and use your own tissue in the form of fat graft or flaps to replace the volume loss of the implant.
Capsular Contracture Surgery – If one has had a capsular contracture, the goal would be to remove and replace the implants preferentially below the pectoralis major muscle, and perform an anterior capsulectomy, use textured gel implants, and do copious triple antibiotic irrigation as well and use JP drains after ascertaining complete hemostasis. Even then, one can have a higher rate of contracture recurrence if one has had previous capsular contracture.
Removal of implants and capsule, replacement (if desired) with textured breast implants wrapped with Acellular Dermis. Transcutaneous fat grafting has been shopwn by some authors to be an alternative method.