Your doctor is correct that doing something different the second time is the right choice. However changing from a saline to silicone implant won't make much difference in your chances of getting a capsular contracture. The contracture is caused by unclear reasons. It isn't just a reaction from your body, or it would have happened on both sides. It isn't just bleeding or infection, because it happens in people with no problems and even many years after surgery.
So, without knowing the cause, you need to do something different. I would agree with changing from saline to silicone. It couldn't hurt. If your implant is subglandular, or on top of the muscle, you should have it moved into a submuscular pocket. I would not recommend the reverse. Your doctor may want to consider textured implants to fool your body to form less of a capsule. It has been less effective under the muscle, but again, it can't hurt.
Changing the size does not matter. You may need a bit of a lift if your skin has stretched significantly. Your risk of a capsule is however greater than 1%. If you have already developed a capsule, you are at a higher risk of forming another capsule. Your risk is probably 4-5% of having a problem in the future. It may be higher, but that is not a reason to hold off on surgery. If you have a painful contracture, have it corrected and massage alot post op.
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