Capsule contraction: should I switch from silicone to saline?

I got a breast aug only 6 mons ago with 375cc mentor gels and developed a capsule contracture of my right breast. I am having revision surgery but am concerned with only operating on 1 breast. My PS is recommending removing the capsule and silicone and inserting a brand new silicone implant but I am concerned that I will have asymmetry with only 1 breast getting worked on. I am torn as to what I should do. Should I just operate and revise the affected breast, or should I switch both to saline?

Doctor Answers 17

Should I switch from silicone to saline for capsular contracture?

You are asking the right questions and I like that you are paying attention to your gut feelings. You're most likely having a right sided capsulectomy. If your left side is perfect, common sense would suggest to leave it alone to avoid getting a poorer outcome on the left side after re-operation. There is no guarantee that your capsular contracture will not come back on the right side after the capsulectomy. There are several things to discuss with your surgeon to possibly maximize your chances of success:

1. Performing a complete capsulectomy as opposed to a partial capsulectomy or capsulotomy.

2. Doing a site change: especially if your implants are over the muscle , considering going under the muscle to decrease capsule formation. This would probably necessitate operating on the other side as well to retain symmetry.

3. Changing your implant to the new 5th generation textured silicone implants. I like Sientra because in a few recent studies they have shown capsular contracture in less than 5% of cases (under the muscle), and they have a waranty to back up their claim (this may or may not apply to redo cases). Having different implants might also necessitate operating on both sides.

4. Consider using a drain on the right side for a limited time. .

5.Consider using low dose Singulair off-label to reduce inflammation peri-operatively and decrease chances of capsular contracture as supported by the UCLA studies.

6. Start early mobilization and shoulder rolls immediately after surgery. No heavy lifting or exercises for three months however, but avoid sitting frozen. 

Best of luck. 
Daniel Golshani M.D.

Beverly Hills Plastic Surgeon
4.9 out of 5 stars 21 reviews

Capsule contraction: should I switch from silicone to saline?

HI and thanks for your question. Based on the recommendations of removing the capsule, I have to assume that the plan is a capsulectomy. If it is a total capsulectomy, the constricted pocket will be made larger. Unfortunately and in my experience the side that undergoes the total capsulectomy does not match the un-operated side, thus there is a difference. It's possible that it could be a sub-total capsulectome and that nelrgement of the oocket will not be significant and will not differ much from the other side. 

It's a judgement call and the person in the best position to make suggetions is your surgeon. There are inherent risks and complications in re-do surgery. So, if all is well with the left side, why subject you to these risks? I would defintely use gels and not saline.  Good luck

Jose Perez-Gurri, MD, FACS
Miami Plastic Surgeon
4.9 out of 5 stars 232 reviews

Capsule post aug

I think you should just have the one side done and I would go with silicone but maybe consider a textured implant..Ithink this is a very appropriate course of action.

Robert Brueck, MD
Fort Myers Plastic Surgeon
4.9 out of 5 stars 62 reviews

C apsular Contracture After Breast Augmentation

Capsular contracture is an unresolved problem with breast implants.  The data from several studies appears to show lower capsular contracture with textured implants, cohesive gel implants and under the muscle (subpectoral) placement of the breast implants.  When a patient has an early unilateral (one sided) capsular contracture, the typical treatment would be to treat that as an isolated event.  The typical treatment may include the removal the implant, removal the thickened capsule and placement a brand new implant only on that side.  When a patient has had multiple surgeries for capsular contracture, the plastic surgeon may then want to consider more aggressive therapies including bilateral (both sided) breast implant exchange, capsulectomies and exchange for textured cohesive gel implants with the placement of Strattice or SERI surgical scaffolding.

Kent V. Hasen, MD
Naples Plastic Surgeon
4.8 out of 5 stars 65 reviews

One implant replaced

Your plastic surgeon has probably made the most suitable recommendation by advising you to have just one implant replaced. 

Jerome Edelstein, MD
Toronto Plastic Surgeon
5.0 out of 5 stars 176 reviews

Breast Augmentation

With unilateral capsular contracture, I would not recommend removing and replacing both implants with saline.  Unilateral capsulectomy with implant exchange is a reasonable approach to this problem.

If you decide to replace both implants, I would recommend switching to textured (as opposed to smooth) gel implants, for a lower capsular contracture risk.

Wishing you all the best!

Tracy L. Cordray, MD
Charleston Plastic Surgeon
5.0 out of 5 stars 4 reviews

Capsular contracture

If only one implant is involved and the other implants is not too old, then it should be fine to just have one treated. Best of luck.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 28 reviews

Capsule contraction: should I switch from silicone to saline?

Dear kp,
I'm sorry that you developed the complication following your breast augmentation. Try as we might, we cannot make this complication rate zero. With a unilateral contracture, I see ow reason to abandon your gel implants. If this was a problem with your body "not accepting" the silicone gel, the contracture would likely affect both breasts. The appropriate surgery would be to perform a "capsulectomy" (remove all of the scar tissue around the implant) and replace your implant. This is likely to fi the problem in a high percentage of cases. The reason behind changing the implant to a new one is that a high percentage of capsular contractures are caused by a "sub-clinical" infection. Since bacteria can adhere to the surface of the implant, putting the old implant back in may just start the process over. If your left breast is fine, the risks of operating on that side are probably higher than any benefit that would be gained. Sorry you have to go through another surgery but have patience and good luck.

Kevin L. Smith, MD, FACS
Charlotte Plastic Surgeon
5.0 out of 5 stars 42 reviews

Capsulectomy and implant replacement for capsular contracture

Revision surgery for a capsular contracture should include removal of the scar capsule (capsulectomy) and replacing the implant, and there is little reason to switch to saline especially since that would mean operating on both breasts. Consider Strattice to help prevent recurrence of the contracture and to replace the tissue removed with the capsulectomy.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 52 reviews

Capsular Contraction: should I switch to saline

I agree with other surgeons that if you are happy with one breast and the current size, only operate on the problematic side.  The right approach is to do a total capsulectomy which will necessitate a drain. There is good data to indicate that doing a total capsulectomy is much more successful than lesser procedures in preventing future capsular contracture when replacing implants. That being said, there is increasing evidence that an important cause of capsular contracture is biofilm on the implant (small amounts of skin bacteria which adhere to the implant upon insertion, and cause inflammation which results in contracture).   Saline implants are inserted without being filled, so it is easier to use a "no touch" technique where the implant never touches the skin with saline than silicone. I would discuss your concerns with your surgeon.

Thomas A. Mustoe, MD, FACS
Chicago Plastic Surgeon
4.8 out of 5 stars 95 reviews

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.