Case-33045 Gallery

Before and after bilateral breast implant revision in a 28-year-old woman with contracted implants. They had been in place without any issues for several years – after a dental infection, she noticed a change in their shape, with her breasts becoming taller and more elongated, and that they hardened.

Capsular contracture is thought to be due to bacteria in the bloodstream that travel to the implant space. The body mounts an inflammatory response to wall off the microorganisms, creating extra scar tissue that contracts around the implant. This condition must be treated surgically – oral medications or supplements cannot treat it.

We ensure that there is no active infection before proceeding, waiting 6-12 months before proceeding with a revision to allow any inflammation to calm down. In this case, the patient wanted to go a little smaller and only the sides of the pocket required opening, so she was a candidate for in-office capsulotomy and implant exchange under local anesthesia.

She was given an oral anti-anxiety medication and offered inhaled laughing gas to breathe during the numbing injections. Her existing incision in the inframammary fold was used to open the implant space and remove her implants. Scar tissue on the inside was opened up, and a representative piece of capsule was sent to the Microbiology lab at the hospital to look for bacteria.

In this case, no bacteria were detected, which bodes well for healing without recurrence of capsular contracture. Had bacteria been found, antibiotic sensitivity analysis would direct antibiotic treatment which would be prescribed for two weeks. Implant massage is important to begin soon after a revision like this in order to keep the implant space open so the implant can move around subtly.

New smaller smooth round silicone gel breast implants were placed back on top of the muscle, in the subglandular position. No drains were needed. Long-term follow up photos are shown 2 years after surgery, without any recurrence of scar tissue. She is grateful that she did not need to go to sleep, and that the recovery was so straightforward!