60 years old, 600cc subglandular silicone implants - Capsulectomy without lift with 20 year old implants? (Photos)

Question

60 year old with 20 yr 600cc subglandular silicone implants. The left breast is soft and fine, the right is probably Baker grade III. I’d like to remove the capsule and replace same size implants without a lift or messing with nipples.

Yasemin Aydinli, MD · Answer

I understand the wish to keep the surgery simple, but I want to be honest about what usually happens in your situation. After 20 years with 600 cc implants above the muscle, the breast skin and tissue have been stretched considerably, and the contracted right side currently looks tighter and higher than it truly is. Once that capsule is removed, the tissue relaxes, and the breast drops; replacing the same large implant into a loosened subglandular pocket tends to give a low, heavy breast with the implant visible and a high chance of the contracture returning. What I would recommend instead is a capsulectomy combined with a lift, moving the implant under the muscle where the recurrence rate of contracture is lower, and choosing a somewhat smaller implant, since the lift reshapes your own tissue and less implant volume is needed for a full result. I know that means scars and nipple repositioning, which you wanted to avoid, but at 60 with this history it is the plan most likely to give a good, lasting result. Whether your skin can tolerate a simple exchange without a lift can only be judged by physical examination, but from your description I would not expect it.

Harry T. Haramis, MD, FACS · Answer

You can remove capsule and exchange for similar implants without a lift. Breasts will look similar, may want to increase slightly.

I would also recommend changing both implants since they are 20 years old.

I would recommend mesh for the capsule side to greatly decrease risk of recurrence.

An exam and consultation with a plastic surgeon is recommended to further discuss your options and expectations.

Paul E. Chasan, MD, FACS · Answer

Thank you for your question. I've been in practice for over 30 years, and revisionary breast surgery is a large portion of my practice. In fact, I wrote the only paper on how to place implants from on top of the muscle to below the muscle. I'm very experienced at this. Generally, capsular contracture is much more common in subglandular space. Also, you have aged implants, and it's quite possible that your area of capsular contracture is caused by a rupture. In your case, I would remove part of the capsule and place the implants under the muscle. Unfortunately, when you do that, the whole skin envelope drops and is unstable and therefore, you will definitely need a lift. You should be able to have a beautiful result.

Best wishes to you.

Best wishes to you.

60 years old, 600cc subglandular silicone implants - Capsulectomy without lift with 20 year old implants? (Photos)

Answers (3)

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