A patient writes: I had my first breast augmentation on July 7th this year with smooth silicone implants under the muscle. My left breast started contracting in week 7 and now at my 3 month post-op my surgeon recommending replacing the implant and using Strattice this time. I am only wondering if my breast is now inflamed and contracting, would it be better to wait a few more months for the inflammation to go down before doing the surgery, so that the current inflammation doesn’t affect the outcome?
Dr. Nein’s response: Fortunately with modern surgical techniques for breast augmentation, the likelihood of capsular contracture has diminished significantly. The current risk is less than 10% for implants placed submuscularly. Statistically about 80% of women who get capsular contracture will develop it in the first two years and in my personal experience the vast majority of those will develop contracture in the first 2 to 6 months. There is no exact science as to when is the optimal time to perform a capsulectomy but I would probably wait until the process has stopped for about a month. In other words once the contracture is no longer getting worse or changing, then wait 4 to 6 weeks before having the capsulectomy performed. I personally wouldn’t use Strattice for the first episode of capsular contracture. I’ve only had one capsulectomy redevelop contracture; so the odds of getting a resolution to the capsular contracture without the use of ADM (acellular dermal matrix) are quite good. I would avoid the extra expense for something that probably is not necessary and that doesn’t guarantee that contracture won’t recur. If someone has had multiple recurrent contractures then ADM would be a very reasonable option.