Is It Common to Reuse the Old Breast Capsule when Going Larger in Cc's?

You should see a Board Certified Plastic Surgeon for this problem.  Usually, a capsulotomy on some level is performed, but each case is unique.  This is not a case for someone not familiar with these problems, thus the reason I recommend you see a Board Certified Plastic Surgeon.  If your surgeon is not comfortable with the problem, then see at least 1 or 2 Board Certified Plastic Surgeon and evaluate their opinion.  To remove a capsule usually takes 2-3 times the time to put the breast implants in the first place, so yes it will be expensive.

Ciera, it has been my experience that after deflation, the capsule begins to contract and get smaller and the longer the time of deflation, the smaller it gets and the harder to open it up. And you went 100cc bigger as well so the capsule probably needed a bit of work, either aggressive capsulotomies, neo-capsulization, as described by Dr. Laverson, or some degree of capsulectomies. But having this degree of hardness right after surgery seems to indicate too much untreated old capsule.

I may not understand the problem completely but if the only problem you had was a deflation, and the only thing your surgeon did was to exchange a larger implant for the deflated implant, without either taking out the previous capsule, or performing multiple capsulotomies, than "yes" I think your pain is due to "reusing" the old capsule. It should be logical that stuffing a larger implant into a small space won't work well. On the other hand if there were other issues in play such as implant malposition, thin skin, or other things that made your surgeon concerned about controlling the location of the new implant, than "reusing" part of the capsule (neo-subcapsular) has become a commonly used technique. Hope this helps and doesn't make you more confused.

It is difficult to respond to your specific circumstance without more information.  Was your initial implant saline or gel?  If gel was ruptured and capsule was not removed, then you likely have residual silicone that may be contributing to contracture.  It is common to create a virgin pocket anterior to an old capsule, a technique popularized by Dr. Patrick Maxwell.  This applies to patients, in my opinion, with non-calcified capsules with intact implants.  Otherwise, my preference is to remove the old scar (capsule) prior to placing a new implant.  Replacing a new implant into a contracture is generally not recommended.  It sounds from your narrative like you did not have a contracture on the replacement side, just a ruptured implant.  In this case, it is not uncommon to remove the ruptured implant (if it is saline), open the capsule to develop a new pocket, and place the new implant in the new pocket, which incorporates elements of the old non-contracted capsule.

Without knowing more about your situation and exactly how your procedure was done, it is impossible to answer completely.

Whether one's existing breast implant capsule is maintained, released or removed during an implant replacement/exchange depends on numerous factors. If it is a simple implant exchange due to deflation and the previous implant position was satisfactory and the new implant will not be appreciably bigger, then the implant capsule would be maintained. If the implant exchange involves a significantly larger implant, then the implant pocket would be enlarged by doing capsular releases. If the existing implant capsule had prior problems (capsular contracture, calcification) or the implant has previous positioning issues, then the capsule would be removed with the implant exchange. These are general guidelines that may change based on each patient's circumstances and other factors including the quality and thickness of their breast tissue and overlying skin.