Risk of Capsular Contracture with implant exchange
Exchange of implants is unlikely to increase the chance of capsular contracture. Exchange of smaller implants is not simple removing the large ones and replacing it with a smaller size. It requires several steps:
The large pockets have to be closed,
Any capsule that has formed should be removed and,
The pockets adjusted for the new implants.
Since you are down sizing the implants, you may not need to lower the pocket. However, your surgeon should be able to make the right surgical decisions.
If your implants have no evidence of capsular contracture now, changing to smaller ones in the same pocket should not increase this risk. I personally prefer submuscular implants even in body builders and personal trainers, but I wouldn't recommend you change to submuscular if you are having no problems above the muscle.
Stay with your current implant placement
I agree with your concern that subglandular implants could develop capsular contracture. In addition, new operation / re-operation may possible lead to contracture (but so could sub-muscular repositioning). I do not think the chances of contracture would be higher to use the same pocket.
Having new, smaller implants in the same pocket sounds reasonable to me given your good results with your current implants. After examining you, your surgeon will advise you whether some form of breast lift (mastopexy) or internal pocket tightening (capsulorraphy) would be needed to optimize your result.
Replacing your implant with a smaller one in the same pocket should be fine if using a gel implant.
Replacing your implant with a smaller one in the same pocket should be fine if using a gel implant. If you are thin with little breast tissue, you will want to avoid a saline implant in the subglandular position to avoid rippling. With regards to capsular contracture, you should be fine keeping your implants in the same pocket if you currently have soft breasts.
Realize, however, that anyone with silicone implants can at some point develop a capsular contracture. There is evidence to show that the submuscular position has a decreased incidence of capsular contractures but this may not be your best option at this point and given that you are a personal trainer.
A smaller implant is fine in the same pocket
Since you have no problems with your implants currently, if you want to go smaller, then I would keep the implants in the same pocket. The body does a good job of ridding itself of extra space, and since your capsule is currently in good shape, it usually will continue to be after explant/reimplant surgery. Since you are a trainer, your skin may be in good enough shape to tighten around the smaller implant, but you can't rule out the possible need for a mastopexy. Discuss these concerns with your surgeon so you can both decide on the best course of surgery. Good Luck.
Keep the implants in the same pocket.
Amelie82, Unless you have some problem with the shape or level of the implants, you should have the new implants placed in the same pocket. If you change pockets, it will require more dissection and a longer surgery and may not end up looking as good as they do now. Good luck with your surgery.
No increase in capsular contracture risk with smaller implant placement
Placing a smaller breast implant into a large pocket should not per se increase your risk of capsular contracture. The smaller implant in a larger pocket will drop the implant a bit, which is what you want.
If you want to reduce the chance of capsular contracture to the minimum possible then I would consider placing the new breast implants under the muscle. Sub muscular breast augmentation reduces the risk of capsules.
Depending on how much skin laxity has been caused by the previous breast augmentation, submuscular implantation may not be possible, but usually by detaching some of the lower muscle fibers, the implant can drop lower and the excess breast skin will re drape nicely.
Your plastic surgeon can advise you as to your optiuons after examining you.
Some surgeons worry that any opening of the tissues around an implant does increase the risk of capsular contracture.
In my experience, if you did not form capsules the first time, and the operation is done meticulously with no bleeding, then it is unlikely you will develope a capsule following replacement with a smaller implant.
R & R Should Not Increast Potential Capsular Contracture
Removal and replacement of
breast implants should not increase the potential for capsular contracture in
someone who has had no previous history of this problem.Since you have not had problems with subglandular
implant placement, there’s no benefit to moving implants to a submuscular
position.In fact, this maneuver might
be associated with an increased surgical morbidity.
In some cases, it might be necessary to perform a
capsulorrhaphy to decrease the breast pocket size when smaller implants are
used.If you’re considering removal and
replacement, it’s important to discuss these issues with your plastic
surgeon.Your surgeon should be able to
formulate a treatment plan that addresses not only your anatomic findings but
your aesthetic goals as well.
Capsular contracture risk with implant exchange
To reduce this risk which is due to subclinical infection, I recommend antibiotic, antifungals, and use of absorbable sutures in the pocket.
Implant exchange: Downsize? Change plane? Capsular contracture risk?
Implant exchanges are common. To address your concerns, which are well thought out and valid:
1. Downsizing. If you are not droopy, then you can likely downsize with a simple exchange. If you have thinning of the skin, you are droopy (you can pass the pencil test), or you have visible ripples and wrinkles, you may not be able to just put in a smaller implant without doing some other kind of procedure such as changing the plane or lifting and tightening the skin.
2. Changing the plane of the breast implant. I understand your desire to do an implant in front of the muscle given your profession. I generally steer away from placement in front of the muscle: higher rates of capsular contracture, less natural look, ripples and thinning in the cleavage area, and other issues. If you go to behind the muscle with a much smaller implant, the cosmetic result may be bad because your skin may be thin, loose, or droopy.
3. Capsular contracture risk is lower under the muscle. If you haven't had issues with capsular contracture with your current implants, then that is a less compelling reason to change the plane.