61, 5'2", 129 pounds - Saline submuscular implant capsular contracture softening or deflated? (Photos)

Question

I'm 61 year old woman 5'2" 129 pounds. I've gained 25 pounds in the past year. Current implants are Allergan Natrelle submuscular saline 510cc. Procedure done in 2015 to replace saline implants ruptured in car accident. They always had asymmetry post op, I'm ok with it. The right implant had capsular contracture. The past months it looks and feels softer. I have been gardening using upper arm strength and lifting 50 pound bags. Is the right implant deflated? Pics attached. Right implant marked in red. Thank you in advance.

Semih Yildiz, MD, FEPOBRAS · Answer

With saline implants, true deflation usually causes a noticeable loss of volume as the salt water is absorbed, sometimes over days to weeks. Your photos show asymmetry, but they cannot reliably tell whether the implant has deflated, the capsule has softened, the pocket has changed, or your breast tissue has shifted after weight gain. A previously firm capsular contracture that becomes softer can also make the breast look different without the implant necessarily leaking.
Heavy lifting or gardening is not a common cause of saline implant deflation by itself, but any new change in size, shape, firmness, pain, redness, or swelling deserves an in-person exam with a plastic surgeon. They can compare the sides, check the capsule and pocket, and order ultrasound or other breast imaging if needed. If the breast is clearly losing volume or symptoms are worsening, I would not wait long to be seen.

Daniel Barrett, MD · Answer

Dear HappyCallie,

I understand your concern. However, without a proper assessment, it would be difficult to determine what is wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Brian K. Reedy, MD · Answer

Thanks for your question! It doesn't look deflated. My guess is that things are changing as your body is changing. If it does deflate, you will notice a substantial difference. Best of luck!

Gianfranco Frojo, MD · Answer

I would recommend deflating the implants and waiting 4 weeks before proceeding with a breast revision including pocket work, pocket support, new silicone gel implants, and a repeat breast lift (anchor pattern). This is a complex breast problem that requires a highly experienced breast surgeon. I would ensure that your future surgeon has
1) certification by the American Board of Plastic Surgery (ideally also a member of The Aesthetic Society or completed an accredited The Aesthetic Society fellowship)
2) performs these procedures frequently and has extensive experience
3) performs the procedures at an accredited facility with proper hospital admission priviliges
4) has good photos and reviews available in person or online

Kadir Berat Oyur, MD · Answer

It is very common for saline implants to eventually lose volume over time, and given that yours were placed in 2015, a slow leak or deflation is a strong possibility, especially if you have noticed a significant change in firmness and shape. While the weight gain you mentioned can affect the appearance of breast tissue, the fact that the side previously affected by capsular contracture now feels softer often indicates that the saline is no longer providing the internal pressure it once did. The strenuous upper-body activity from gardening may have made this change more apparent, but it is unlikely to be the sole cause of a rupture. To be certain, a physical examination and an ultrasound or MRI would be the best next steps to confirm the integrity of the implant and discuss whether a replacement is necessary to restore the symmetry and comfort you desire.

Jeffrey M. Darrow, MD · Answer

One of the benefits of saline implants is that if they get a break in the shell, the salt water, which is inside the implant, slowly leaks out and is absorbed by your body. This usually results in a very gradual deflation of the implant so that the breast looks smaller. From your photos, I don’t note any decrease in volume or change in the appearance of your breast, so it appears that your implant is intact. If any further changes occur, you should check with your Plastic surgeon. Best wishes.

Ned Snyder, IV, MD · Answer

Thank you for submitting your questions/photos!  With saline implants, if there is a rupture causing them to deflate, you would notice a big change in breast volume very quickly.  Patients tend to wake up in the morning and notice a “flat tire” on one side.  It is normal to have breast changes over a period of time due to many factors, such as hormone changes, weight fluctuations, etc.  I advise you to seek out a board certified plastic surgeon to examine you and make recommendations.  Good luck and thanks again for reaching out!

Gary M. Horndeski, MD · Answer

It does not appear your implants are ruptured. You would noticed a marked difference if they were ruptured since they are saline. Your body would adsorb the saline water and your breast would flatten. I recommend explantation and breast lift using the Bellesoma. The implants are removed, your breast tissue is reshaped creating upper pole fullness, elevated higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided and nipple sensation (in 95%) is maintained if not injured during your previous surgery. Later, fat transfers can be performed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Zoran Potparic, MD · Answer

Saline implant would significantly deflate and create visible deformity within days after incident. There is no doubt that you have serious capsular contracture which requires implant replacement and placement of new implants in different pocket. Smaller implant should  be considered. Good luck.

Donovan Rosas, MD · Answer

One advantage of saline implants is the ease of diagnosing rupture. Deflation is a clinical diagnosis that can be made without imaging. A saline deflation will be come self evident several days after device compromise. It will slowly lose volume and the saline fill will be absorbed by the body. Patients will eventually note a "flat tire."

Based on your photos, the right breast while asymmetric appears to be maintaining some measure of its fill. As time passes, progressive change will be indicative of a problem. Monitor for further changes. However, if you stabilize/plateau it is unlikely to be a device related issue.

As always, discuss your concerns with a board certified plastic surgeon (ABPS).

61, 5'2", 129 pounds - Saline submuscular implant capsular contracture softening or deflated? (Photos)

Answers (11)

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