I have 25 year old silicone implants over the muscle with Baker Grade II capsular contracture. I have just had a mammogram which showed no obvious leaks. I am torn trying to decide whether to replace them as they still look pretty good but just feel pretty hard. I would be devastated to go thru all that and come out looking worse or the cc recurs at a worse Grade than before.
25 Year Old Silicone Implants w/ Capsular Contracture - Replace?
Doctor Answers (18)
Aging Implants and Capsular Contracture
As implants get older, especially silicone, it has been shown scientifically that implants get hard with time and if they begin getting significantly hard and painful they need to be replaced. That usually happens within 10-15 years. I would definitely seek out your Board Certified Plastic Surgeon to see if you need implant replacement which will include capsulectomy as well if you have silicone implants.
Silicone implant contracture
Whenever you consider "redoing" an operation, I think of what would or could be done differently this time. First of all, the fact that your implants are 25 years old means that your new implants will be of better quality. The new generation implants of today are far superior to those manufactured 25 years ago. Also, you could choose to place your implants under the nuscle- a position that decreases their palpability and reduces the likelihood of capsular contracture. You may wish to consider replacing the implants with saline implants, which also have a lower incidence of capsular contracture. There is also a good chance that your current implants have at least a small leak undetected by mammogram. This is more likely if the capsular contracture recently got worse(possibly due to the leak). Leakage is also known to be generally more common in silicone implants that were placed 10 or more years ago.
Replace 25 year old implants
If you were my patient, I would suggest removal and replacement of the implants and the capsule as well-unless your implants are above the muscle (I would imagine they most likely are) I would place new implants submuscularly. My concern with doing nothing is continued capsular contracture that really distorts the shape of your breast and results in you needing a mastopexy as well to correct the deformity. Good luck!
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If you have a tight capsuel and the implants are over the muscle, you should probably have them exchanged and placed under the muscel.
Old implants above the muscle should probably be replaced
While it is possible that you could go another 25 years without trouble with the implants, the fact that you are developing a capsular contracture suggests that it is a good time for new ones. These should probably go under the muscle. Discuss it with an experienced plastic surgeon since these are not routine cases. You have time to gather information and think about it, no urgency.
Repairing capsular constracture
It is true that anytime you have surgery for capsular contracture, it is possible for it to recurr. But that being said, it is most likely that your grade II contracture will be much better and you will enjoy having soft looking AND feeling breasts. Good luck!
When to replace your implants
Your implants are 25 year old silicone breast implants and the capsular contracture may represent a rupture. Your mammograms may not show the rupture. Your concerns of having a worse outcome after revision surgery is always present, however your surgeon can help you manage these risks. Also, the new cohesive gel silicone implants we are using rupture less than the devices you currently have.
25 year old silicone implants with capsular contracture
This is a difficult decision whether to replace them or not. Yes, another surgery could be worse if not carefully planned and executed. On the other hand your implants will continue to deteriorate with time. The wall will weaken and you may have a rupture with worsening capsular contracture. It is hard to tell when this will happen but if you wait long enough it will eventually. The surgery is easier before there is rupture of the implant. If the capsular contrature bothers you I would remove/replace them before it gets worse.
Replace your 25 year old silicone implants
Twenty-five year old silicone breast implants should be replaced. If you have capsular contracture developing, then there is a chance that your implants are ruptured even if the mammogram did not show it. Mammogram is NOT the test of choice to evaluate the integrity of a silicone implant shell. The best test is an MRI. However, if your implants are not ruptured now, it is very likely that they will be soon. If you were my patient, I would advise you to replace them now.
Deciding whether or not to remove and replace old implants
Although it seems you're happy with mild capsular contractures, you're implants are pretty old. I've exchanged old implants and discovered one or both was leaking or ruptured, even though it wasn't expected. If the rupture is contained within the capsule, its messy, but not a big problem to fix. It the rupture becomes extracapsular, the silicone in the surrounding tissues is often impossible to remove completely. New silicone implants have better, longer chained silicone molecules, and don't "leak" like the old implants did. Seek out an experienced plastic surgeon to evaluate you. It might be best to exchange the implants now, place them in a new, likely submuscular pocket, and head off a more complicated situation that could arise if you do nothing.