Breast Implant Replacement or Lift After Capsular Contracture?

I am a 39 years old with 300 cc saline textured breast implants over the muscle for 15 years. Almost a year ago, I noticed hardness and discomfort on my right implant and confirmed I have a grade 2 capsular contracture. I am undecided whether to replace implants with smooth saline ones or remove them altogether and get a breast lift.

I was a size A breast but have had 2 kids. I am a full B cup with implants. I wonder if having the additional scars from a breast lift with smaller breasts will be more difficult psychologically than just having them replaced? My objective is really to avoid having further breast surgeries!

Doctor Answers 13

Decision for lift or implant replacement

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I am assumming that you have saline implants in place. If you do and if youare going to do some type of surgical procedure you could have the salt water drained from the implants in the office with a simple needle and syringe. This will give your and your surgeon an idea as to what amount of breast tissue is there and give you a better idea what would be left with a lift alone. Once you get the idea of the volume you have there you can decide if you want more volume(add implants) or willing to accept the scars associated with a lift and not heving to think about implants again.

Harrisburg Plastic Surgeon
4.5 out of 5 stars 37 reviews

What is the right breast procedure for me?

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Hi there-

The best advice I could give you, and it is what I would tell my sister, is that you first must firmly decide what you would like to look like, taking into consideration all of your other thoughts about your preferred lifestyle, clothing choices, etc...

Once you have a good understanding of the appearance that you want to present to the world; the one that will keep you smiling as you walk by mirrors and shop windows, then it's appropriate to research the options for achieving that look.

It is my opinion that, depending on the above, you could achieve a very pleasing and natural outcome by removing the current implants with their associated scar tissue, and replacing them with new implants under your muscle. At the time you had the initial operation the prevailing wisdom differed from today- but I can tell you that placement of textured saline implants on top of the chest muscle is not a technique I would ever recommend nowadays...

Alternatively, removing the implants and having a breast lift would also give you pretty breasts- but they would of course be smaller and less full. Only you can decide whether the scars of a breast lift are worth it or not, and of course, this depends a lot on the way they heal...

Your decision should be based on whether you prefer the breast size and silhouette you currently enjoy, or if you would rather be free of the implants, have smaller breasts, but with some additional skin scars. (BTW, the scars don't need to be heinous- find a surgeon who can show you photos of prior patients with scars that are thin and inconspicuous).

Implant Replacement and lift

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Your contracted saline implants need to be removed along with a complete capsulectomy and creation of a new virgin space for a new implant. I would replace with gel implants and perform an areolar reduction and lift, however as long as you have implants you will always have to deal with reality that another surgery is likely in your future as these devices like all man made devices are prone to failure, wear and tear and someday need replacement. Removal without replacement will likely result in a very small breast as it looks like the implant probably makes up the majority of your breast volume.

Paul Rottler, MD
Saint Louis Plastic Surgeon

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Breast lift versus Mastopexy - What's the best option

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Hi Confused,

The best option ultimately has to decided upon by you. If you really want to avoid having future surgery, your best option is to have your implants removed and to have a breast lift. Because the majority of your breasts are implant, the continued presence of implants will likely mean more surgery as you get older.

Unfortunately, removing your implants and performing a mastopexy probably will not look all that nice. Not only will your breasts return to an A cup, but the supporting ligaments of your breasts have probably been stretched out by your implants. Without implants, your breasts will likely look pretty saggy within a short amount of time after surgery.

If you want the best cosmetic result, your best option would removal of your current implants with capsule removal, conversion to silicone implants below the chest wall muscle, and a breast lift. That will give you the nicest appearance, but in no way guarantees that you won't need future surgery.

Hope this helps. Best of luck.

Should my breast implants be removed and should I have a breast lift?

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You have some ptosis( breast drooping) and enlargement of the areola.The implants with capsular contracture are now too high and adding to the deformity. If the implants are removed and not replaced and a traditional breast lift performed you would end up with smaller breasts without projection and you may be more unhappy with the scars.

My recommendation would be for you to consider having the existing implants removed and replaced with 300cc. silicone gel implants placed sub-muscularly. I would also recommend either a peri-areolar breast lift (Benelli) of if necessary a vertical mastopexy.

In summary:

1.The gel implants are very long lasting and would offer projection.

2. Sub-muscular implants are less likely to have contracture

3. A peri-areolar mastopexy (lift) would have the least scarring and solve the problem of large areola

Hope this helps.

Joel B. Singer, MD
New York Plastic Surgeon

Breast implant replacement OR a Breast lift

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Dear Confused,

If your stated goal is REALLY "to avoid having further breast surgeries! " THEN you should have your implants removed and have a breast lift. Placing an implant guarantees that those implants WOULD leak sometime in the next twenty years and have a 15% chance of capsule formation (probably higher in you since you already have it).

A breast lift without implants would produce smaller but perkier breasts. (In addition, your large areolae would be reduced to a more attractive 4cm or so diameter but you would have a vertical scar from the areola down to the breast fold). (Removing the implants without a lift would most likely produce a "Rock in a Sock" deformity).

If you wanted to maintain the breast projection, I would go with either a saline or silicone gel filled implant under the muscle. The key is to pick and implant that can be covered by your breast tissue.

Good Luck.

Peter A. Aldea, MD
Memphis Plastic Surgeon

Breast lift or implant removal and replacement

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The most important sentence you have written is: "My objective is really to avoid having further breast surgeries!" If this is the most important issue than you should remove the implants altogether and have a breast lift. Your breasts may be small but this is the only way to minimize the chance for future surgery.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

Breast implant replacement

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 Quite honestly, you do not have a very good looking result at this point from your augmentation.   Above the muscle saline is suboptimal and exchanging the implants for below the muscle gel with a lift would make you look so much better.

Breast implant revision breast capsulectomy silicone breast implants

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If your goal is to minimize future breast surgeries I would suggest the following: remove the saline implants, replace your breast implants with silicone implants, place these implants under the muscle, and perform a limited breast lift or mastopexy.Once your implants are removed, I do not believe you will be happy with the resulting volume, even with a lift. Therefore, I think you need implants. Silicone implants have less capsular contracture rates compared to saline breast implants when placed under the muscle.If you elected to have both breast implants removed and not replaced, you would need a significant breast lift or mastopexy. This would probably result in a T or an anchor mastopexy. If however, you just replaced your breasts implants, you may not even need a lift.One thing I would consider is insurance coverage. Often a breast capsulectomy and removal of breast implants are covered medical benefits. Even though most breast implants were placed electively for cosmetic reasons, most insurance plans cover capsulectomies. Please have your plastic surgeon seek for authorization for this often covered surgical procedure.Good luck. Sincerely Dr.Katzen

J. Timothy Katzen, MD, FACS
Los Angeles Plastic Surgeon
5.0 out of 5 stars 254 reviews

Surgery for Capsular Contracture

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There's good new here believe it or not. Nowadays the risk of capsular contracture is very small with submuscular implants. I thing the majority of the capsular contracture had to do with either the antibiotics placed into the pocket during augmentation or the bleed of silicone oil from the implants. Either way none of that happens today.

So you do need a minor lift but this can be done via periareolar incisions, i.e. no vertical scars. I would recommend removing the implants and capsule, placing the new implants under the muscle, doing he periareolar, small lift and enjoying the beautiful breasts you will have. It doesn't matter if you get silicone or saline when the implants are placed under the muscle.

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.