Is Breast Implant Replacement Needed on 15 Year Old Saline Implants? I Have Capsular Contracture in Both. (photo)

I got breast implants 15 years ago. After having my children (2 in the last 5 years), I started to feel pain in both breast. My breast hurt once in awhile, not always. I am happy with the look BUT they are hard. Both seem to evenly have CC. If I were to redo, I would have them replaced with Mentor Silicone Gel. The risk of them hardening is high so my question is do I replace or leave alone. I DO NOT want a lift which was already recommended. (too much scarring for me)

Doctor Answers 10

Treatment of capsular contracture

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The minimum treatment is removal of the capsule and implants.  It is difficult to comment on the risk of capsule formation after silicone implants under the muscle as you have not noted whether your implants are above or below the muscle.  If you leave the situation as is, the capsule is likely to worsen and create a more difficult operative scenario down the road.  You would do well with a lift unless you are willing to accept the position of the breasts with ptosis.  That is a personal decision.  If you scar well, I do not think that this should be the critical impediment but can understand your thoughts on this matter.

Breast implant revision

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Thank you for your question.  From the look of your photos and the description you provide, it does seem that you may very well have a capsular contracture.  Unfortunately the treatment of a capsular contracture is removal of the implants and surrounding capsule.  It would of course be up to you and your plastic surgeon whether you wished to replace the implants at all.  To get the best cosmetic result you would likely need replacement of the implants as well as a breast lift (mastopexy.)
Best of luck,
Christopher Davidson, M.D.

Capsular contracture

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Thanks for sharing your photos.  Based on your photos and your description, you have capsular contracture on both breasts.  When you experience pain/discomfort on your breasts and see cosmetic distortion due to capsular contracture, you want to replace implants and undergo capsulectomy. I do agree that breast lift will give you a better shape.

Explant vs. Exchange

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You state that you do not want a lift because of the scarring.  However, there is a new technique, which uses only a circumareola incision.  Your breast tissue is reshaped creating upper pole fullness, elevated higher on the chest wall and more medial to increase your cleavage.  Aligning the areola, breast tissue and implant over the bony prominence of the chest wall gives maximum anterior projection with a minimal size implant.  I always recommend small silicone gel implants placed retro-pectoral since they look and feel more natural, are more stable, less likely to ripple or have complications needing revision.            


Best Wishes,


Gary Horndeski, M.D.

Gary M. Horndeski, MD
Texas Plastic Surgeon
4.6 out of 5 stars 230 reviews

What do you want?

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When you have symptomatic contractures but are happy with the look and not wanting a lift, you have to decide if things are good enough and tolerable as they are and if so, then nothing needs to be done.  Removing your capsules will invariably change the breast shape which could make the lift even more important in achieving a satisfactory look.  And then pocket location (above or below muscle) also have some impact so your history needs to be reviewed, your breasts evaluated in person, and your expectations discussed before a plan can be formulated.

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews


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If you have pain and hardening, you will benefit from replacement with the anatomic highly cohesive gel implants

Norman Bakshandeh, MD, FACS
New York Plastic Surgeon

Capsular contracture

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Removing the implants and capsule is a start. Considering re-augmentation with implants below the muscle and/or with strattice may help diminish the risk of recurrence.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Capsulectomy, implant replacement plus Strattice for capsular contracture

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In the presence of capsular contracture, implants should be replaced and the scar capsule removed (capsulectomy.) It appears that the tissues are already thin and don't support the implants well, and capsulectomy will make this worse - leading to more sagging. A Strattice internal bra will help prevent recurrence of the contracture while adding coverage and support for the new implants. Whether this is enough to avoid having a lift would need to be determined with an in-person consultation.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 59 reviews

Think again

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You need to have the implants and capsules removed. I would replace them with silicone and do a mastopexy. What you want is not always the best thing for you. Talk to an experienced surgeon and look at photos -- the scars are usually not too bad.

William B. Rosenblatt, MD
New York Plastic Surgeon
4.2 out of 5 stars 12 reviews

Replacing your saline implants

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Obviously pictures alone cannot give the full picture, but it is likely that you have capsular contracture. This would explain them feeling hard and also the pain. The treatment would be to remove the scar tissue, replace the implants, and move them to under the muscle, if they are currently over the muscle.  The current gel implants are excellent and I think you will find that they feel and look much better than even new saline implants. You should set up a consult with a board certified plastic surgeon who specializes in revisional breast surgery because exchanging old implants with capsular contracture can be quite tricky.  During your visit, you can talk about size and whether or not a lift will be worth the additional scars. In the right hands, you should expect a very nice improvement.

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.