Capsular Contracture of Saline Implants

This is a great question and capsular contracture is something that I help my patients with in my Bay Area practice frequently. One of the most common reasons for people with implants to have additional surgery is capsular contracture.
There are four grades of breast capsular contracture - The grading is as follows:

Grade I the breast is normally soft and looks natural
Grade II the breast is a little firm but looks normal
Grade III the breast is firm and looks abnormal
Grade IV the breast is hard, painful, and looks abnormal.

Some patients actually prefer the look of mild capsular contracture (grade 1-2).
Many theories have been proposed about the formation of capsular contracture but current literature indicates that it is likely an immunologic response.
The following techniques have been employed to fight capsular contracture:

submuscular breast implant placement - likely has a role in decreasing capsular contracture
using textured implants - many recent studies show this is not an effective in preventing capsular contracture
limiting handling of the implants and skin contact prior to insertion - follows the immunologic basis of capsular contracture indicating that less handing causes lower bacterial contamination and is likely an important concept in preventing capsular contracture
irrigation with triple-antibiotic solutions - as above although care about solution selection must be used as some solutions void the warranty of the breast implant.

In my practice I have found submuscular placement of breast implants, avoiding handling as much as possible of the implant and triple antibiotic irrigation of the implant and the pocket significantly reduces capsular contracture numbers.
A study in 1984 and in 1990 examined saline vs. silicone capsular contracture rates and actually found silicone to be higher but this was likely secondary to the fact that a RUPTURED silicone implant causes much more of an immune response and is likely to cause capsular contracture. It is not clear that there is a large difference between intact implants and also not clear if the newer silicone implants - if they were to rupture - would have the same problem.
Treatments for capsular contracture have included:

Closed capsulotomy (disrupting the capsule via external manipulation), a once common maneuver for treating hard capsules, has been discouraged as it can cause implant rupture, poor efficacy, reforming of the capsule and patient pain.
Nonsurgical methods of treating capsules include massage, external ultrasound, leukotriene pathway inhibitors (Accolate, Singulair)

However the most reliable and common way to treat capular contracture is to remove the capsule and replace the implant. Sometimes we recommend delaying replacing the implant to lower the risk of capsule reformation in extreme cases.

I hope this helps!

In my experience as well as many other surgeons, Saline implants have a higher rate of capsular contracture.

Silicone implants have a higher capsular contracture rate profile. However, patients with implant palpability, thin breast tissue, and previous contracture are candidates for softer silicone implants. The risk of developing recurrent capsule is still quite high.
The solution to the problem of capsular contracture depends on symptoms. There is a classification scale of contracture that is designed for diagnostic and planning purposes by a plastic surgeon.
You may consider very aggressive postoperative management of your breast implants to avoid recurrent capsular contracture. This may include oral medications, massage, and firm pressure postoperatively depending on your specific plastic surgeons requirements.

The short answer is that there is probably no increased or decreased risk with silicone implants versus saline. One thing the surgeon may consider is placing the implant in an new plane (for example, if your current implants are in front of the muscle, placing them behind the muscle). Short of that, when the old implant is removed and replaced, the steps that can help reduce your risks are:
removal as much of the existing, hardened capsule as safely possible
meticulous attention to bleeding so that there is no blood around the new implant
meticulous attention to reducing the chances of infection, including IV antibiotics at the time of surgery, bathing the implant in an antibiotic irrigation before they are placed, and oral antibiotics after surgery
gentle massage of the implants beginning within a couple of weeks of the procedure
Despite these steps, you may still develop a contracture, but in my opinion these steps can help reduce your risk.

Your chances are increased to develop capsular contraction, but not necessarily from the type of implant used, saline or silicone. There has been an excellent discussions posted answering your question. I am in agreement with Dr. Williams’ detailed answer and would like to hit upon a few highlights.
You are at an increased risk for scar capsular contraction because you had it before. The exact cause of scar capsular contraction is unknown, but likely sources that have speculated and studied include:
1. Bleeding and exposure to ‘iron’ from blood
2. Subclinical infections resulting in “biofilms”
3. Silicone bleed
4. Immune response
Steps to prevent the above causes should be taken, which include: meticulous efforts to stop all bleeding at the time of your revision surgery, conversion to submuscular placement of the implants, appropriate antibiotic coverage and rinsing the pocket or space out with triple antibiotics, and using new implants either low-bleed silicone or saline implants.
It is imperative that you have thorough discussion with your plastic surgeon to discuss all options as it applies to you and your inherent risks and potential complications.
Thanks for your question.