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Revisions in Breast Implant Surgery

How Do We Rescue Your Breast?  Dealing With Capsular Contracture or Implant Malposition

Capsule formation is a natural process of healing around any implant; not necessarily a breast implant. There is no true “normal” capsules; Just variations. Capsules  are a layer of scar tissue the body forms circumferentially around a breast implant. They may be ideally soft or unusually hard. To complicate matters, the timing of capsule formation, the type of breast implant getting encapsulated, as well as the chest wall shape that the encapsulation is occurring on, all influence breast  appearance outcome.

For the purposes of simplicity, capsule formation has classically been gradiated in four grades. Grade 1 being soft capsules not influencing breast implant shape. Grade 2 capsules are firmer and make the breast implant subtlety firmer. Most women don’t even realize they have this type of scar formation. Grade  3 and 4 scar capsules alter appearance of the implant and generally will necessitate revisionary surgery.

Interestingly, grade 1 capsules- not even palpable, and leaving implants ideally soft, may also have an implication in reoperation  for conditions known as implant malposition.

Here, for instance, if the chest wall is keel shaped or curved, and implants are saline filled, and negligible  scar essentially forms around the implant, then , the implants may insidiously migrate low and laterally. Not ideal, and not where surgeon or patient had envisioned for the outcome. This requires selective capsulectomy and capsuloplasty for management. This means tightening the lower and or lateral internal space so the implant can’t migrate as well as removing part, most, or all of the remaining capsule so allow for better projection or position of the new implant. If the muscle was incompletely divided medially, the forces exist which would tend to push the capsule laterally. Switching to silicone gel implants and properly dividing muscle often helps stabilizes and neutralize the physiologic dynamics associated with implants under muscle. Most often I see this incompletely done – in effect underestimating what it really takes to get a great outcome. Some of the best of the best beautiful breast outcomes come from rescues I’ve performed as secondary augmentation.


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