How long can I safely wait to replace silicone implants? Is 4 months too long? Minimize capsular contraction complications?

Question

I've had implants for 30 years (3rd set in 2009), and capsular contracture w/ the last two sets. In Feb. I took a hard fall running. Mid March I had MRI that concluded implants ruptured. Can I safely wait until July to replace, or should I take care of this ASAP? Possible negative results of waiting? During surgery, should I be tested for ALCL or lymph complications? What can be done to minimize capsular contracture that has occurred with the last 2 sets?

Michael R. Schwartz, MD · Answer

Thank you for your question.  Replacing possibly ruptured implants is an important question.  The generation of implants from 2009 are somewhat cohesive (not as good as todays newest generation).  As long as your report says that your rupture is intra-capsular (inside your body's natural scar tissue), you can probably wait a bit, but not too long.  The idea is to remove the implant before it can have the loose gel get into any breast tissue.  I would certainly recommend that July is the longest you wait.  The negative would be that the the gel escapes and causes inflammation in the breast tissue leading to problems with capsular contracture now and in the future. 
As far as ALCL, this has only be shown to occur in patients with textured implants.  I imagine yours are smooth, and you should not need to worry about this.  Your consultation should clear up that concern.  
Decreasing the chance of capsular contracture can be done in several ways, from choice of incision, pocket location, surgical technique, implant type (textured is better) and use of acellular dermis (skin product to support the breast and prevent capsules).  Each of these has pro's and con's so they need to be discussed in your consultation.
Hope this helps.  Seek out a board Certified PS for your revision.  
Dr. Schwartz

Robert Kearney, MD, FACS · Answer

I think it is most likely safe to wait.  The MRI scan should tell you where the leak is and  how much  it is - most often they are contained leaks.  To prevent another CC you should have a total capsulectomy and use a keller funnel to put in the new implants. If there is a large leak with silicone in the breast tissue you might want to get it done sooner rather than later.  Have your PS review your MRI scan.

Urmen Desai, MD, MPH, FACS · Answer

Although the earlier the better, it is not dangerous to wait.  To minimize capsular contracture, I like to use an incision along the breast fold, use an ultra sterile technique, and place the implants under the muscle.  The implant selection should be based on a combination of your desired size, soft tissue dynamics, breast base diameter and skin elasticity.  I recommend an in-office examination as well as a detailed discussion with a surgeon who you are comfortable with.   Finally, make sure your surgeon is a Double-Board Certified Plastic Surgeon certified by the American Board of Plastic Surgery, a member of the American Society of Plastic Surgery (ASPS) and the American Society of Aesthetic Plastic Surgery (ASAPS).Best,Dr. DesaiBeverly Hills Institute for Aesthetic Plastic SurgeryHarvard Educated, Beverly Hills & Miami Beach Trained, Double-Board Certified Plastic Surgeon

Lisa Cassileth, MD, FACS · Answer

There is no perfect answer to this, because if the silicone is ruptured, some patients will immediately start getting capsular contracture and then the delay will mean a tougher surgery as the capsule will need removal. However, many more patients have little to no reaction to the free silicone, especially with the newer cohesive implants, and it is trapped within the capsule. My answer is that it is not an emergency and try to get it done within a 6 month time frame if you have no physical evidence of rupture (like contracture or  changes of the breast appearance). Now on the other hand, you have a history of contracture, I wouldn't wait until July, you are asking for trouble. In addition to the swap, you may also want to send the capsule for biofilm cultures and pathology to figure out why you have the contracture in the first place and try to minimize recurrence.

Tim Sayed, MD, MBA, FACS · Answer

Hello,As others have stated, while the earlier the better when dealing with ruptured silicone implants, if your implants are recent generation cohesive gel, there is unlikely to be significant risk associated with waiting a few months to remove. Just make sure it is your plan to remove and/or replace the implants, as we do not recommend leaving ruptured implants in place indefinitely. Certainly rupture could have been the cause of capsular contracture (did you have an MRI between when you had the surgery and when you had the hard fall?). The main ways of addressing a capsular contracture would include a possible pocket change (look up "neosubpectoral pocket" for some visual descriptions of what's involved in one common way of managing this) and replacement of the implants using a "no-touch" technique, commonly involving a Keller Funnel. Having said that, recurrent capsular contracture is still a risk - there may simply be a biologic reason your body tends to form thicker capsules than the average patient.ALCL is rare and generally associated with late development of fluid collections (seromas) around implants as opposed to being associated with rupture or capsular contracture per se.

Curtis Wong, MD · Answer

its safe to wait until convenient for you.  There is no danger to waiting as you have scar tissue and cohesive gel and it will not migrate into adjacent tissues.  You do not have to worry about ALCL unless you had a marked change in your breasts that would raise suspicion.  As for minimizing contractures in the future, changing implants and pockets then consider no touch technique, antibiotic irrigation,  textured implants, and possible an ADM wrap for the implant.

Sean Kelishadi, MD · Answer

Hello and thank you for your question. I understand your concerns given that you had the unfortunate situation of having had capsular contractures.  If I were you, I would see a board certified plastic surgeon with expertise in breast revision techniques; I think that the sooner you remove your implants, the less likely you are to have inflammation that would lead to capsular contracture, but I wouldn't operate on you until I made sure that your bruising/swelling is improved so that there are no impaired judgements made affecting your symmetry when picking a new implant size for you. There are many techniques that can be utilized to decrease capsular contracture that are alluded to in the video below, but others too that can be discussed in person. As for ALCL, it is a very rare circumstance, and it is mainly caused in older textured implants, but a quality board certified plastic surgeon would be able to tell you if this was something worth working up.  Given that your problems started from a fall and not a breast that suddenly became larger 7-20 years after surgery, I think it is unlikely you need to worry about that at this point. I hope this helps and best of luck to you!Sincerely,Dr. Sean Kelishadi

How long can I safely wait to replace silicone implants? Is 4 months too long? Minimize capsular contraction complications?

Answers (7)

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