Larger Breast Implant Often Placed After Capsular Contracture Removed
Thank you for your question. If you want to be the same size after removal of a capsular contraction you should discuss with your plastic surgeon the possibility of placing a slightly larger implant during your surgery. Also be sure to discuss with your surgeon whether the surgeon feels you should have the new implant wrapped with a dermal substitute such as Strattice or AlloDerm to help prevent recurrence. In addition a textured implant will have less chance of another capsular contraction.
If on the other hand you want smaller breast after your revision there is absolutely no problem with placing a smaller implant after removal of the capsule however be aware that a smaller implant may produce slightly more sagging.
These ideas are based on the fact that when a capsular contraction is removed the space of your breast implant pocket is made larger so that placing the same implant size may result in a smaller looking breast.
Best of luck - this is a really difficult arena - ok to replace with either the same or larger or smaller size. Most important will be what is done to the capsule. Best of luck.
Removing silicone 395cc to saline should I get the same size. Having second capsular contraction surgery?
I think that getting the same size, upsizing, or downsizing may all be reasonable based upon your desires. This will not have an impact on capsular contracture recurrence. Find a plastic surgeon who performs a lot of revisions for this and is an expert in the field of dermal matrices.
Kenneth Hughes, MD
Los Angeles, CA
Implant Considerations in Re-Augmentation
Breast re-augmentation involves a more detailed surgical plan than primary augmentation. In cases of capsular contracture, for example, the entire breast capsule should be removed in addition to the implant. The existing capsule may be colonized with bacteria, and this can contribute to re-formation of the unwanted contracture. The resulting new pocket must be shaped to fit the new implant, and several (capsulorrhaphy) sutures are required to achieve this goal. The UNinvolved side also needs capsulorrhaphy sutures, particularly at the inferior pole of the breast to recreate the breast fold. Breast implants tend to "Bottom Out" with time... This causes the illusion of the nipple moving up on the breast mound; in reality, the implant is moving down onto the abdomen.
A reasonable approach is to use the same or slightly larger implants. The larger implants can account for the soft tissue stretching that has occurred with the previous augmentation procedures. The slight increase in size can also combat against some of the tissue shrinkage that has occurred in capsular contracture.
Another key consideration is the decision to use textured implants. Silicone breast implants with surface texturing have a decreased risk of developing capsular contracture when compared to smooth implants (when placed over the muscle). It reasons that the same protective benefit would be present for re-augmentation under the muscle. Speak to your board certified plastic surgeon to determine which procedure and implants are right for you.
I would want to know what is going to be done differently with the new surgery then the last. I would also ask whether a protein matrix has been considered. It is not the size of your implants that is causing contracture