Complications of Breast Implant Replacement After 23 Years?

I have had breast implants for 23 years and developed capsular contracture on one side after 18 years, after starting to play volleyball. I need to replace them and I want to go smaller. I have 410cc's sub-muscular, low profile, silicone. I would like to use a higher profile for less width and go with something in the low 300cc/high 200cc. My ribcage is fairly small. What are the complications of this type of revision after this amount of time? I have a very small amount of ptosis, and my implants sit pretty high because they are so big. Will or can higher profile implants sit a bit lower to blend with my natural breasts?

Doctor Answers 9

Replacing worn silicone gel implants is important

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Most silicone gel breast implants that have been in place 23 years will have developed a leak into the capsule surrounding the implant. The leak can present itself as a drawing or tender sensation in the breast, calcifications around the and within the capsule, and very often capsule contracture or a firming up of the implant. The contracture can set in slowly and will cause the implant to round up and sit high on the chest just as you describe. Patients who have had an augmentation over many years may not feel that this appears that abnormal, and the implant contracture can mimic a high profile gel in use today. In the best of situations an implant should be replaced before calcification and contracture begins, if not the capsule should be completely removed at the time new implants are placed. Capsulectomy will dramatically improve the shape and feel of the breast. The size of the implant will seem smaller as the capsule is released, and there is no problem if you wish to be smaller still. Work carefully with photos and bras before as implant sizing is best determined at the time of surgery.

Best of luck,


With capsulectomy and smaller implants, adjustment of the pockets will be necessary

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When we remove implants from that era, it is common to find that one or both implants have leaked, and this is likely related to the firmness that has developed in your breast. It would be very reasonable to remove both implants along with the surrounding dense capsules, and place new smaller implants. The size, shape, texture, profile, and even saline vs silicone would be decided based on careful assessment of your remaining breast tissue, chest wall shape and dimensions, and your expectations and goals.

With smaller implants, it would be necessary to "take up" the pockets, especially laterally to avoid having the new implants fall off to the sides of your chest, particularly when you are recumbent. Obviously, when your old implants are removed, your breasts will be more ptotic, and with smaller implants, you might need to consider a breast lift. I do think that the upper pole fullness could be decreased to provide a more natural look.

Michael D. Yates, MD
Huntsville Plastic Surgeon

Revision breast surgery

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You situation is fairly common.  Certainly you can have surgery to remove the capsule and replace your implants.  Going to a smaller implant may warrant a lift. 

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Correcting capsular contracture and wants to go smaller

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Hi Gardenpath. In this situation I like to use the style 410 implants from Allergan. These are available through an FDA approved study by plastic surgeons who are investigators for the study. These are silicone implants that are more cohesive than the currently available silicone gels. Early results show low leak rates and less capsular contracture. They come in many widths. As for high profile silicone implants, this is an option for you, as it will help the ptosis intially. However you may need a mastopexy in the future, or perhaps even now, especially since you have ptosis with a larger implant in place. After capsulectomy and putting in a smaller implant, the ptosis will be worse. The main risks from the surgery is recurrent capsular contracture, you could be dissatisfied with the aesthetic result and the usual complications/outcomes that can occur with any implant surgery such as infection, leaking implant, etc. The removal of the capsule usually requires the placement of a drain for 1-2 weeks; other than this, the surgery is straightforward. The reason the implant is not blending with your breast is for one or more several reasons. 1) The capsular contracture can be displacing it upward; this will be corrected by capsulectomy. 2)The implant pocket was never low enought to begin with-this can be adjusted. 3)the implant is sitting in one location and the breast tissue, which is ptotic, is in a different location; in other words, the breast tissue is "hanging" off the implant. All of these issues can be addressed by the revisional surgery. Hope this helps.

Tracy M. Pfeifer, MD, MS

Implant exchange and capsular contracture

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When you have a capsular cntracture, the scar tissues need to be released and removed and the implant replaced. You can replace both implants, staying under the muscle and go smaller if you desire and you can increase the profile and narrow the base as long as it is still appropriate for your body. At that point, the best scuplting surgeon can taylor your lax skin and lift the breasts to give the best final result possible for you.

Implant remove and replace

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When capsular contracture occurs, this in and of itself, can make the implants appear higher riding.

The simple act of doing a capsulectomy will lower the impants. If you require further lowering of the implant pocket, this can be accomplished during the procedure as well.

There are risks to crossing the street or flying in an airplane and, of course, there are risks to any surgical procedure. These risks can occur regardless of surgeon or technique. These include but are not limited to: infection, hematoma, discomfort, wound breakdown, hypertrophic scar formation, asymmetry, unfavorable healing, implant infection exposure, rupture, deflation, palpability, visibility, distortion with muscular contraction, capsular contracture, interference with mammography or surgical evaluation of breast masses, interference with nipple sensation with nursing and aging as well as alteration in shape with nursing and aging, need for secondary surgical revisions, and inability to guarantee a specific cosmetic result. Although many other claims of diseases associated with silicone breast implants have been reported these have not been substantiated by major studies

Breast Implant revision after 23 years

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From the information you have given I would suspect that a low 300 cc high profile implant may fit your needs. It sound like you would be best served to have a sizing done at the time of the surgery to se what size and shape will work best to fill your desires. Sometimes you just don't know before the surgery. Under those circumstances we have a sizer available at the time of surgery along with a variety of sizes and styles of implants. the surgeon then tries to match what the desires the patient has expressed prior to the surgery.

Breast implant replacement after 23 years

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Several facts to consider - After 23 years with silicone filled breast implants -
- you would have lost a varying amount of breast tissue. This becomes very noticeable when the implants are removed.
- the odds of one or both implants having silently leaked is quite high ( and MAY account for the capsule)
- the act of partially or completely removing the scar around the implant(s) (Capsulectomy) with the implant would result in creation of a larger pocket under the breast. Such a pocket MUST be narrowed. It is is not the implant will slip to the side or lower AND be associated with a flatter breast.

To make up for the creation of a larger pocket and breast atrophy, many surgeons simply put a larger implant in. It requires less customizing in the OR and is much quicker. In your case, I would suggest you consider Mentor High Profile silicone gel filled implants OR Mentor Style 2000 Moderate Plus saline implants. For the best accuracy and in compliance with your wishes, ask your surgeon to use intra-operative SIZERS (temporary implants). These would guide him/her based on their size (IE your desired "low 300cc/high 200cc") how tight to make the new pocket and where vis a vis the nipple as well as which implant s to open and place in those pockets.

Good Luck.

Peter A. Aldea, MD
Memphis Plastic Surgeon

What can I expect after Capsulectomy and Implant Exchenge

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Hi there-

Your questions are way too specific for responsible answers to be given without an examination...

I believe very strongly that the implant used for any particular patient should NOT be chosen based (solely) on the patient's goals for shape and size. Rather, the best outcome will be achieved when an implant that is appropriate for the patient's body type, dimensions, chest wall diameter, and breast diameter is used. Determining this requires a careful examination.

Your best bet is to find a plastic surgeon certified by The American Board of Plastic Surgery who does a lot of breast surgery and visit them for a consultation.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.