Yours is a fairly common scenario: long-standing augmentation without problems and now you've developed a late capsular contracture. There is a reasonable chance that one or both of your implants have ruptured, as this can cause a capsule to thicken, and the mammogram may have made matters worse by causing more trauma to the breast. Regardless of what is happening with your implants, you have several options. Certainly removing your implants is a reasonable choice, and removes any chance of re-developing a capsular contracture. If you have enough tissue that you can end up with a satisfactory size then this often works well. In some cases, there isn't enough volume in the native breast and a new implant is necessary. If your implants are 20 years old then there is a good chance that they are above the muscle. My treatment of choice in patients like you is a total capsulectomy on both sides, a re-augmentation beneath the muscle, and a breast lift when indicated. While there is a chance of recurrence of the capsular contracture, placing the implants in a new plane after a total capsulectomy reduces this dramatically.
Find a board certified Plastic Surgeon with broad experience in revision breast surgery and you should be able to improve your situation significantly.
It sounds as though you enjoyed a good result for many years following your breast augmentation. Sometimes a late one-sided development of a capsule contracture may suggest leakage of the underlying silicone implant. If you had a one-sided contracture it would suggest that something happened in that particular breast such as silicone leakage to cause the problem. It doesn't sound as though your body spontaneously reacts to the implants with formation of a capsular contracture. This would suggest that you would have a satisfactory outcome if you had removal and replacement of your implants. Very often in the face of a capsule contracture it is best to remove the capsule and place the new implant in a different tissue layer. For instance, if your implants are currently on top of the muscle your surgeon may elect to place your new implants under the muscle layer. In the event that your implants are currently under the muscle is surgeon may decide to place the new implant in the layer between the backside of the muscle and the capsule covering it. You of course have the option to simply have the implants removed.
Although it's hard to assess without pictures, most likely you have implant rupture and capsule contracture. Implants placed in Europe could also be pip implants that were recalled for problems. Traditionally it was felt that breast augmentation and lifts shouldn't be done at the same time, but more recently many plastic surgeons have safely offered both procedures at the same time. It really depends on your breast tissue and capsules. Thin tissue can lead to necrosis and nipple loss when doing both procedures. You should see a surgeon who has experience with breast revision surgery and have a consultation.
Capsular contracture after a mammogram is not uncommon and may be related to the mechanical disturbance of bacteria within the breast ducts. In any case, a breast lift after implant removal is fine in most cases. Depending on your natural volume you may also want to consider fat grafting or adipose stem cell enhanced fat grafting to restore some volume. A picture would be helpful to better advise you.
I would find an expert in breast augmentation and lifting in your area and get examined to determine what may be the best treatment for you. It is very difficult to determine this without an exam.
Kenneth Hughes, MD
Los Angeles, CA
There is no way to comment on your situation specifically without at least some photos. The chance of ruptured implants is quite high based on your story and you need to have that checked out. I personally do not do lifting at the time of removal for most patients because the breasts recontour remarkably well after explant for most patients and they find out they no longer want the lift. Wait 2-3 months after explant before making that decision.
Old silicone gel implants often present with capsular contracture. Capsulectomy (removal) and implant removal is effective at preventing another contracture, but can leave an overly deflated looking breast. Concomitant breast lift (mastopexy) can greatly improve the results.
There are other surgical techniques that may prevent contracture and allow you to continue with new breast implants. Finding the best answer for you personally would entail consultation with experienced board certified plastic surgeons in your area. Ask your own physician and any nurses you know to recommend surgeons. Plus the American Society of Aesthetic Plastic Surgeons has a referral service. Website: surgery.org