Will My Previous Surgeries Compromise My Chances for a DIEP Procedure?

This week, Dr. Richard Kline of The Center for Natural Breast Reconstruction answers your questions.

Q:  I am BRCA 1 positive and researching prophylactic mastectomy with immediate reconstruction. As far as I can find out, DIEP is not available in TN. I am planning to have a bilateral salpingo oophorectomy at some point in the near future and have had 2 previous C-sections. Does that exclude me from being a DIEP candidate?

A: Thanks for your question. Most likely your previous  surgeries have not compromised your chances for DIEP breast reconstruction. In fact, I see patients frequently who have been told they can not have a DIEP, and in fact it works quite well. I would be glad to get more info and could be more specific. Let me know.

 Q: I’m considering implant-based breast reconstruction. My surgeon mentioned a “risk of capsular contracture.” What exactly is that?

A: Capsular contracture is an abnormal response of the immune system to foreign materials in the human body. Medically, it occurs mostly in context of the complications from breast implants and artificial joint prosthetics.

The occurrence of capsular contraction follows the formation of capsules of tightly-woven collagen fibers, created by the immune response to the presence of foreign objects surgically installed to the human body, e.g. breast implants, artificial pacemakers, orthopedic prostheses; biological protection by isolation and toleration. Capsular contracture occurs when the collagen-fiber capsule tightens and squeezes the breast implant; as such, it is a medical complication that can be very painful and discomforting, and might distort the aesthetics of the breast implant and the breast.

Although the cause of capsular contracture is unknown, factors common to its incidence include bacterial contamination, rupture of the breast-implant shell, leakage of the silicone-gel filling, and hematoma.

Moreover, because capsular contracture is a consequence of the immune system defending the patient’s bodily integrity and health, it might reoccur, even after the requisite corrective surgery for the initial incidence.

The degree of an incidence of capsular contracture is graded using the four-grade Baker scale:

• Grade I — the breast is normally soft and appears natural in size and shape
• Grade II — the breast is a little firm, but appears normal
• Grade III — the breast is firm and appears abnormal
• Grade IV — the breast is hard, painful to the touch, and appears abnormal

Dr. James Craigie

Center for Natural Breast Reconstruction

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Capsular Contracture From Breast Implants

The below question is answered by Charleston breast surgeon Dr. James Craigie of The Center for Natural Breast Reconstruction.

I have had two failed breast reconstructions using an implant. First was placed too high up, and the second one anchored down with abdominal advancement flap. After 5 months the implant began to disappear. MRI proved it was not ruptured. Doctors were not worried  and I was told to stop worrying about it, so I continued on with my life. I then developed chest pain, muscle/ligament/joint/back pain and breathlessness when climbing hills or stairs. Eventually after 2 and a half years, I referred back to PS who told me I had a chest wall concavity due to the implant being forced inwardly under pressure from the scar tissue and muscle. The implant size was 770cc. Will this concavity “spring” back into place or will I have it for the rest of my life? Also what effects might this have on my body if my frame is being pushed out of alignment?


Thanks for your question. I’m sorry you have had these problems. We see people whose chest wall and ribs become indented due to implants quite frequently. The problem develops because body reacts to the implant by making scar. We call this capsular contracture and in some people it can exert tremendous force due to constant pressure. The process will persist as long as you have an implant. We have not performed scientific studies to prove the ribs return to normal but we have treated hundreds of patients with this type of problem by removing the implants and replacing them with their own tissue with out taking their muscles. This has solved their problems related to implants permanently. I hope this answers your question, let me know

James Craigie, MD
Center for Natural Breast Reconstruction

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What are the Next Steps if Capsular Contracture Occurs from a Breast Implant?

The below question is answered by Charleston breast surgeon Dr. James Craigie of The Center for Natural Breast Reconstruction.

What are the next steps if capsular contracture occurs from a breast implant?

The next step would depend on how severe the capsular contracture is.  All implants will develop a capsule and this may slowly lead to changes in the shape or in the most severe cases painful scarring and hardness.  When symptoms develop it may be necessary to surgically intervene.  The next step would depend on whether the patient has had radiation and the available options for reconstruction.  The first step and the least involved regarding surgery would be capsulotomy or release of the scar. Sometimes the healing process, whether there was an infection or a bruise around the breast, could have increased the risk for capsular contracture. Other times it may simply be the body’s reaction to an implant.  If after capsulotomy or capsulectomy the contracture has not resolved, the next step would be to consider moving additional healthy tissue to cover the implant or to remove the implant and replace it with your own tissue.  30% of our patients who choose to undergo autologeous reconstruction have had prior implant reconstruction and their bodies have developed severe capsular contracture.  If someone has had radiation, the capsular contracture will be more severe and most likely once problems develop the problems will continue.  Therefore, when multiple capsular contracture procedures have been necessary; our recommendation would be to consider removing the implant and replacing it with your own tissue using a muscle-sparing procedure.  Your own tissue would not develop capsular contracture and it is the most successful way to solve problems resulting from implant reconstruction.

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