Case of the Month: Breast Revision 2


While most breast implants never cause problems, some women experience changes after surgery that warrant a revision, such as capsular contracture.

Breast Revision for Capsular Contracture

  • Procedure: Left Breast Capsulectomy with Acellular Dermal Matrix
  • Patient:  Age: 65, Weight: 125 lbs, Height: 5’4”
  • Photos: 8 months’ post-surgery

This 65-year-old retired teacher had capsular contracture of her left breast that developed after her initial breast augmentation procedure.  Her left breast became tight, uncomfortable and asymmetric. After 2 failed attempts by another surgeon to correct this conduction, she researched extensively to find a plastic surgeon with specialized expertise in Breast Revision surgery. She found Dr. Michael Cohen and was very impressed with his extensive experience and skill.

Dr. Michael Cohen determined that the left breast implant and capsule needed to be replaced. He performed a capsulectomy with acellular dermal matrix and replaced the implant on the left breast.  The patient was finally able to enjoy the beautiful, soft, natural-looking breasts she desired.

What is Acellular Dermal Matrix

Acellular dermal matrix (ADM) is a soft tissue substitute that is derived from natural tissues.  Dr. Cohen often uses Acellular Dermal Matrix in breast implant revision surgeries because the implant position often needs to be corrected.  When implants are too low, too lateral, or too close together or too close to the center, they need extra support to maintain proper position. Dr. Cohen uses an ADM to create a bra-like structure that supports the breast shape, the position of the implants, and helps reduce the chance of capsular contracture recurrence.

Why do complications occur?

Whenever an implant is used for breast augmentation, your body naturally creates an encapsulating sheet of scar tissue that lines the breast implant’s pocket. This scar tissue is called a “capsule” and naturally forms a few weeks after the breast augmentation procedure. The capsule is important for it keeps the breast in the proper position. It lines the surgical pocket and provide a smooth, strong interface between the breast implant and the soft tissues of the chest. By reinforcing the pocket, the capsule protects the implant, keeps it from sliding around, maintains its proper positioning.

The perfect capsule is strong enough to maintain proper implant support, but soft and thin enough to not be felt. Problems occur when capsules become either too hard or too soft, causing Implant Malpostion – in the wrong position (too low, too high, too much to one side, etc.) and possibly discomfort.

Too soft – capsulorrhaphy

When a capsule is too soft, it will not provide enough support for the implant. If the capsule is weak on one side, the implant will sag towards that side. If the capsule is soft on the bottom, the implant will bottom out and create a “bubble” underneath. A capsulorrhaphy procedure will tighten and reinforce the capsule so the implant will stay in the correct position.

Too hard – capsulotomy

When a capsule is too hard, it can compress the implants which is called Capsular Contracture. If the capsule is tight on one side, it will push the breast implant toward the soft side. If the capsule is tight all the way around, it can make the implant feel hard and look odd.

A capsulectomy procedure strategically incises the capsule, allowing it to soften, so that the implant will look and feel soft, natural and properly positioned.

Your Consultation

During your Breast Revision consultation, Dr. Cohen will listen to your concerns, review your medical history, examine your breasts and discuss your surgical options. Because it is important to have realistic expectations about your achievable results, we use our innovative VECTRA® 3-D imaging system to show you what your potential results may look like.  We recommend you wait at least 6 months after your initial breast augmentation before considering revision surgery because your body needs that much time to completely heal.

Dr. Michael Cohen

Breast augmentation revision surgery requires advanced surgical techniques to deal with the complexities. It’s very important to select a board-certified plastic surgeon with specialized training and expertise in this area.

Dr. Michael Cohen is one of the leading breast surgeons in the nation and a specialist in breast revision surgery. He has decades of experience and is renowned for his expertise and artistry with these more challenging procedures. Looking and feeling misshaped can be upsetting; Dr. Cohen is committed to helping you improve the look of your breasts so you can feel better about your appearance.

If you are considering a breast revision procedure, schedule a personal consultation with Dr. Cohen today by calling 410.296.0141 or contact us online.

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    Dr. Cohen

    Dr. Michael Cohen is an acclaimed board certified plastic surgeon and has earned an international reputation for excellence in breast augmentation surgery. Read full bio.