The problem with your situation is that capsular contracture is very difficult to detect when there is a deflation. If there was a contracture, it can contribute to deflations because by squeezing the implant it causes creases and folds that weaken the implant. If there was a CC then it is best treated with removal of the capsule, and if the tissue was thin it may be wise to add Strattice for coverage, support, and some degree of protection against recurrence. So it really comes down to knowing whether there was a contracture or not.
My recommendation is that if you have capsular contracture the capsule should be removed as much as reasonably possible. If you do not have capsular contracture then the capsule does NOT need to be removed.
So the real question is: Do you have capsular contracture?
After a saline implant deflates the implant is smaller and usually the capsule cannot be felt. If you remember your breast to be hard and unnatural in shape on that side before it broke, then you probably do have capsular contracture. If it was soft and normal, then you probably do not have capsular contracture. Your surgeon will know during surgery if your capsule is thickened and shrunken or not. He/She will then be able to decide at surgery what the appropriate procedure should be.
That means you should choose a competent, experienced, board certified plastic surgeon, who has done lots of these procedures in the past.
I hope you have a great result!
It is pretty hard to know if a breast with a deflated implant has a contracture unless the patient was quite aware of it before surgery. However, I have frequently found the capsule of the deflated side to be stiffer or thickened at the time of surgery. If it is not, and one is replacing the same size, then no capsular work is needed.
If the finding is that the patient has capsular contracture on the non-deflated side and both implants are being changed, then I always remove the capsule. Current theory is that a bacteria containing biofilm is contributing to the capsule formation. Not removing the capsule predisposes to a higher risk of recurrent capsular contracture.
When larger implants are being placed, then the capsule has to be opened or removed to allow the breast/skin envelope to expand with the larger volume. Otherwise the breast will feel like it has a capsule, tight and firm.
It all depends on what the proposed surgical plan is. A breast with a mild contracture that is not bothering a patient does not need to be operated on for health reasons. If it gets worse and starts to detract from the look and feel of the augmentation or causes discomfort, it can be removed.
From the photos it is difficult to tell whether you have capsular contracture or not. The nice thing about saline implants is a low incidence of capsular contracture. If your undeflated side is soft and you are pleased with it I would simply replace the deflated implant, which should be under warranty. A full capsulectomy should not be needed in my opinion.
Thank you for the good question and picture. Generally speaking, if your breasts have remained soft and the breast implant capsule is found (intraoperatively) to be thin, soft, and pliable, then removal of the breast implant capsule is not indicated. On the contrary, if the breast implant capsule is removed unnecessarily, you will be exposed to increased risk of complications such as bleeding and (quite commonly seen) breast implant rippling/palpability postoperatively. This latter problem is difficult to correct. Again, generally speaking, best not to undergo any procedure that is not absolutely necessary; each maneuver exposes you to additional risk and potential complication. Choose your plastic surgeon carefully. Make sure that he/she has significant experience helping patients with revisionary breast surgery and ask to see lots of examples of their work. You may find the attached link, dedicated to revisionary breast surgery helpful to you. Best wishes.
If they've been trouble free and soft for 14 years, chances are that the capsule is thin, diaphanous, and if removed will immediately be replaced by a new capsule with your new implants. My routine is to leave the old capsule as long as it's not thick, dense, or abnormal. Often, it's necessary to adjust the capsule for optimal position and situation of new implants for breast appearance and size the woman prefers, but if capsule is soft, in my opinion, no advantage in extra surgery to remove it.
Capsular contracture is an unfortunate complication which can occur with both saline and silicone implants. It is related to implant position, blood in the space immediately after surgery and noninfectious bacteria in the space which cause an immune response over time. We define it in terms of the feel of the breast as well as how it impacts the appearance of the breast. To be clear 100% of woman form a capsule. The vast majority of capsules are thin and the breasts feel soft and look "natural". This is defined as Grade 1.
Grade 2- the breasts look great but they feel a bit firm. If this is detected early anti-inflammatory medications like Accolate can be used with some benefit.
Grade 3- the breast is firm and may appear misshapen.
Grade 4- the breast is hard, misshapen and painful.
Grade 3 and 4 capsules should be removed.
The appearance of the left breast in the photo is not consistent with a capsular contracture that requires removal of the capsule.
I would seek out another board certified plastic surgeon to evaluate you and render their opinion to help clarify this matter for you.
I hope this was helpful.
It is difficult to determine if a deflated saline implant pocket has capsular contracture. This is typically determined intra-operative. If your breasts were soft and supple before the deflation AND you exchanged it quickly for a same sized implant you typically would not need any capsule work done. If this is not case you may need capsule work done to one or both sides to help achieve better symmetry. I urge you to see a board certified plastic surgeon in your area.
Thank you for the picture.
In my opinion, I do believe that the implants should be replaced and remove the capsular contraction. If the implants are leaking, soon you might have some kind of deformation.
The question can not be answered over the internet because ONLY IN PERSON examination of the deflated breast allows a diagnostic decision to be made...