Saline Vs Silicone-re Size-capsular Contracture?

Is it true that you need to go at least 100 cc's bigger when switching from saline to silicone implants in order to get the same projection? also-which type is better for avoiding capsular contracture-and dose size make a difference when trying to avoid capsular contracture? Lastly-if I had capsular contracture before does that mean it is likely that I will get it again? How can I avoid a repeat episode (was just on 1 side) thxx!

Doctor Answers 8

There is no difference in the capsular contracture saline vs. silicone.

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In general, the capsular contracture rate is the same for silicone and saline, above or below the muscle, texturized or not. 

Avoiding a capsular contracture

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can be challenging.  But here are the basics I am aware of in order to diminsh the risks for a contracture/recontracture.  Textured implants can help above them muscle.  Otherwise under the muscle is known to be beneficial in preventing contractures.  New pockets and new implants are also important considerations.  Avoiding the armpit or nipple incisions can also affect your risks for contractures, with the inframammary approach the 'safest'.  Good luck with avoiding a contracture.  Your doctor should help you navigate this maze.

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews

Implants and capsule

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A capsule is more likely to develop in someone who does not have adequate excision of the capsule and exchange of the implants.  As for volume it really depends on type of implant chosen.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Implant size not a predictor of capsular contracture

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Unless the implants are so large that stress is put on the tissues, I don' see any reason to beleive that size predicts risk of capsular contracture. If you are changing the implants because of contracture, then it is often a good idea to remove the scar capsule (capsulectomy) which in turn could mean using larger implants to replace the lost volume from that. Another option to consider is using an acellular dermal matrix such as Strattice. That seems to protect against cc, repalces the tissue lost from the capsulectomy, and provide coverage and support to the implant.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 59 reviews

Saline does project further off the chest wall than silicone

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beth5062:Saline to silicone conversions do require choosing an implant which both fills your chest as well as "sticks out" comparably and this often does require choosing a higher volume (cc) implant.  Some PS believe that textured surfaces, smaller volumes (</=350cc) are key elements in preventing capsular contracture, however others support that the submuscular plane and meticulous tissue handling, (i.e no bleeding and/or low grade infection) is more important. I'm not convinced that saline trumps silicone in promoting more capsular contracture.  However once a patient has had capsular contracture, the risk for recurrence, is in my experience, higher, irregardless of changing implants, excising the capsule, use of drains, addition of ADMs (Strattice(, activity restriction, use of Singular (leukotriene A-4 inhibitors) etc.  Hope this is helpful. 

Lavinia K. Chong, MD
Orange County Plastic Surgeon
4.8 out of 5 stars 59 reviews

Saline vs gel implants

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I agree that when going from saline to gel implants,you need to have bigger implants.If this is done to decrease the incidence of capsular contracture, changing from saline to gel will not warranty that it may not happen once again.Dr.Rosendo Martinez,FACS

Rosendo Martinez, MD
Puerto Rico Plastic Surgeon

Capsular contracture and implant placement

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It is true that implant volume should be increased when choosing a gel implant versus a saline filled implant.  100cc may not always be the amount needed, but bigger is better when switching.  As far a capsular contracture is concerned, under the muscle is consistently the best plan.  The implant size is not as important when discussing capsule formation.  The fact that you had a capsule in the past is likely to increase your risk of another, but not absolutely. Many patients need to have surgery to remove capsules, but only on one occassion. As far as the future for capsule formation prevention - the jury is out.  The best result is from delicate capsule removal surgery to avoid  new capsule formation. Good Luck

Neil Gottlieb, MD
Philadelphia Plastic Surgeon

Saline versus Silicone? Prevent Encapsulation?

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 Thank you for the good questions.

 In my experience, I do have to use larger silicone gel breast implants in order to achieve the same “size” compared to saline breast implants. I do not think that the choice of breast implants will make a difference when it comes to avoiding repeat encapsulation.   

Replacing breast implants in the sub muscular position, using a fresh implant, removing as much breast implant capsule as possible, the use of anti-inflammatories postoperatively,   the use of postoperative massage... may all be measures that may be helpful in helping prevent repeat encapsulation.

 I hope this helps.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.