Breast Becomes Smaller when Removing Capsule Scar Tissue?

Question

I recently had a revision for a capsule in my breast. I wanted to remain the same size when switching from saline to silicone during this process. My doctor went up atleast 100 CC's in the exchange ! Could he have possibly went so large because I have less breast tissue now, after removing scar tissue/capsule? Meaning when there is capsule removal, a larger implant is needed to get the same results for size that you would have in a first time BA patient? I am 500CC HD Sil. and want C cup

Vincent N. Zubowicz, MD · Answer

A capsular contracture will artificially supports the volume of the breast implant. A breast capsule has negligible volume. With capsular contracture when corrected the breasts may seem smaller because the volume is distributed differently.

Earl Stephenson, Jr., MD, DDS, MBA · Answer

Removing a capsule does little to change breast volume. The increase in size was probably based on your surgeons judgment. He or she is the only person that can answer that question.

	Good luck.

	Dr. ES

Jourdan Gottlieb, MD · Answer

I have occasionally weighed capsulectomy specimens, finding 25-75 grams depending on thickness, how easily the separate from surrounding tissues, etc. 

	In addition, many surgeons feel that a higher volume of silicone is needed to get the same appearance as a smaller volume of saline.

	What you haven't noted in your question is how recently was the surgery, and whether the breasts seem the same size or not.

	All the best.

Jeffrey Zwiren, MD · Answer

Some breast tissue will be removed when the capsule is excised and it is true that a gel will look a bit smaller than a saline filled implant. Your plastic surgeon will have to use his best judgement to use an implant that will meet your expectations.

Steven Wallach, MD · Answer

In removing a capsule, the amount of tissue removed is usually pretty negligible. As for an increase in volume, that is something to ask your surgeon. It may have been a shape issue.

Tom J. Pousti, MD · Answer

Thank you for the question. Removing breast implant capsule tissue does not necessarily lead to a smaller breast size, but the shape of the breasts can be changed significantly after capsulectomy surgery. As you know, this change in breast shape may make the breasts seem smaller or larger.

	Also, when patients undergo revisionary surgery and have implants exchanged (from saline to silicone gel) they may require a larger silicone gel breast implant to achieve the same “look”. Although there is no direct “conversion”, I have found clinically that a moderately larger silicone gel breast implant is necessary to achieve the same breast size/projection, compared to the saline breast implant that is being removed.

	 Again, there are many variables involved when it comes to revisionary breast surgery. Hopefully, you will be pleased with the long-term outcome of the procedure performed, regardless of the specific cup size achieved. As you know, cup sizes can vary from one bra manufacturer to another.  Therefore, I ask my patients not to base their preoperative communication and/or judgment of the final (postoperative) outcome of the breast surgery on achieving a specific cup size.

	 Best wishes.

Lori H. Saltz, MD (retired) · Answer

There are two reasons for increasing your volume. The first is that when you have a capsular contracture the implants usually move upward making the breasts fuller in the upper aspects. Your perception is that they are larger. Once the contracture is fixed the implants will sit much lower and the upper part of the breasts are much less full. Your perception is that they are smaller. I have found that women need much more volume to feel they are the same size as they were before. The other reason is that saline looks larger than silicone because saline implants are more overfilled than silicone. Now having said these things I still think a 500 cc high profile implant is going to be at least a D cup unless you are a larger girl, but I also think the look is more important than a cup size. If you are happy with the way you look once all the swelling is gone than it doesn't really matter; the procedure was a success.

Breast Becomes Smaller when Removing Capsule Scar Tissue?

Answers (7)

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