Silicone Vs. Saline: Implant Replacement After Capsular Contracture

I'm 28, and I have 425cc Saline breast implants with a capsular contracture ("CC") on my right side. It's severe and painful, and will need to be removed. My doctor suggested replacing the saline with silicone. He said that there is only a 1% chance of the CC occuring again. Is that true? Which should I go for? I also am planning to go smaller, so both implants will be replaced.

Doctor Answers 11

You may want to consider having both implants replaced...

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You may want to consider having both implants replaced under the muscle. Though no definitive data is available, your best option for decreasing capsular contracture would be a site change from the "above muscle" pocket to the "under muscle pocket."

I've recently published an article on this "Pocket Conversion Made Easy: A Simple Technique to Convert Subglandular Breast Implants to the Dual Plane Position" in the Aesthetic Surgery Journal (February 2009).

The costs can vary depending upon whether you plan to replace a right-sided implant or have a pocket conversion procedure. Good luck!

La Jolla Plastic Surgeon

Capsular Contracture and Implants

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Once you have capsular contracture (cc), your chances of having the same is increased. Nationwide, the risk of a primary augmentation and cc is around 7-8% with saline. The new data from one of the implant company shows that their silicone implant CC rate is close to 9%.

This is nationwide, so look at these numbers with a grain of salt. So, silicone is not that dramatically higher as being stated in some of the comments here. You have to weigh the risks and benefits, but in redo surgery, in general, patients have a better cosmetic result with silicone implants as the breast tissue is generally thinned out, so you are more likely to feel the implants if they are saline, and definitely more likely to see the ripples. Massage, massage, and then more massage. Hope that helps.

Farbod Esmailian, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 88 reviews

Your risk is HIGHER than 1%

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Once your body has shown that it "knows" how to make CC, your future risk will certainly be more than 1%. The lowest rates come with saline under the muscle so if you are above the muscle you might consider submuscular conversion. The risk remains higher with gel. Size doesn't really matter so much.

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Silicone implants give better results.

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Silicone implants in general look and feel more natural. But you can get another capsular contracture with any kind of implant, and the risk is more like 5%.

How the surgery is done is more important than what implant you use. Even without seeing you, I can tell you that going smaller is a good idea. You need to have part of the capsule removed to release the contracture (called a capsulectomy) and you also need the pocket made smaller to accomodate the smaller implant (called a capsulorrhaphy).

Even a tiny amount of bleeding can cause capsular contracture, so control of bleeding has to be meticulous. I would consider using drains for you.

Also, even a very low grade infection that you cannot detect can cause capsular contracture. So, the wounds need to be irrigated with antibiotic solution, and you need to get antibiotics by vein.

These are just a couple of examples of surgical details that matter so much.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Many Choices, One Guarantee

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Capsular Contracture (CC) has a variable rate of occurrence, can be unilateral or bilateral, and can occur within months or take many years to develop. Patients who have experienced CC are more likely to have it happen again with subsequent implant replacement. However, if the implants are placed below the pectoral muscle, into a large pocket, and are massaged early in the post-operative period in order to maintain the space around the implant, there may be improvement, or at least delayed development of CC. Sub-glandular implants, whether saline or silicone, have a higher rate of CC. In general, silicone implants may have a slightly greater incidence of CC compared with saline, although both silicone and saline have other benefits and risks which should be considered prior to choosing one versus the other.

With Breast Augmentation, only one thing can be virtually guaranteed in every case. That is, that at some future point, patients will require one or more operations in order to maintain the youthful appearance of the breast because of age-related changes, or to correct problems such as CC or deflation of the implants as they occur.

Athleo Louis Cambre, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 6 reviews

Encapsulation seems more likely with silicone gel implants

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I am not a big fan of silicone gel implants unless you have really thin tissue and are having problems with rippling. In my experience, the silicone gel implants have a very high encapsulation rate over the long term. In fact, my saline implant patients rarely develop capsular contracture. Some patients do prefer silicone because of the feel however.

To say you have a 1% risk of repeat contracture is "guilding the lilly" a bit. Most studies have shown repeat contracture (once you have developed contracture requiring surgery) can be quite common. Now hopefully any contracture you might develop afterward will be less than what you have right now. This should certainly be the case in the short term.

Do you smoke? Smoking can throw a monkey wrench into this. I would decrease or quit this before your surgery if you do.

John P. Di Saia, MD
Orange Plastic Surgeon

Capsular Contracture and Implant Choice

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It's unlikely that your choice of silicone vs. saline will dictate the success of your procedure. Replacing the implants does makes sense, as some capsular contracture (cc) arises due to bacterial contamination of the implant. Going smaller will present some challenges. Depending on your skin tone, you may have excess skin after changing implant size and a breast lift may become a consideration. The internal pocket will be also oversized for the new smaller implant (especially after capsulectomy), and you will need to use a round implant such that rotation of the implant will not create a deformity. Switching pockets or doing a capsulorrhaphy are other important considerations. Good Luck!

Michael Kreidstein, MD
Toronto Plastic Surgeon
4.6 out of 5 stars 33 reviews

Revising and Selecting the Right Breast Implant

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One of the most common problems is breast capsular #contracture or the development of thickening, and contracture of the capsule that exists around the breast implants. Severe capsule contracture probably occurs in less than 15% of augmentation patients. Every woman has a breast capsule around their implant and this is a normal phenomenon. The capsule itself could be as thin as Saran Wrap but may also become calcified and thickened. As it thickens and shrinks, the patient may develop a feeling a firmness of the breasts and in its worst situation, the breast may become painful and abnormal in appearance, achieving a very round, hard, and uneven appearance. There may be distortion and possible breakage and leakage of an older implant, but may also include a newer #implant. Nicotine users, such as smokers, have up to a 30x increased risk of #capsular contracture.

Saline implants may deflate spontaneously. When the patient has significant #symptoms, complete or partial leakage of their saline implant, or concerns regarding silicone leakage, it is recommended that the implant is removed and exchanged. Frequently, this is performed on both sides depending upon the age of the implant. Capsulotomy or opening of the capsule may be required or frequently capsulectomy, which is removal of the scarred capsule, is recommended to ensure adequate pocket dimensions.

With both implant types there are choices when it comes to size, shape, and profile. The criteria best to suit you will be discussed in full detail at your breast augmentation consultation. Each implant have their benefits. #SalineImplants is made with a #silicone outer shell that is filled with saline water during the surgery. It is filled with sterile saline (salt-water). Since saline is like normal body fluid, it is safe and easily absorbed if the implants were to leakThe #implant shell is ordered in a specified size which can be filled to a minimum or maximum fill amount. This allows the plastic surgeon some flexibility with sizing during surgery. Often times a woman has breasts which vary slightly in size. If one breast is slightly smaller than the other, each implant can be filled to a different amount to create better symmetry. Saline tends to be a little less natural feeling than silicone, but it can also create a more dramatic upper breast appearance, which some women prefer. A new saline breast implants option called Ideal Implant™ was recently FDA approved and was created for women who are not comfortable having silicone implants in their body, but desire a more natural feeling implant than traditional saline implants on the market. The unique structure of the Ideal Implant allows for a similar look and feel as silicone with the safety of saline. 

#SiliconeImplants are made with a silicone outer shell and are filled with a gummy-bear consistency silicone on the inside. More women tend to choose silicone breast implants due to the natural feel and appearance. Silicone implants are now made of a cohesive gel which are anti-leak even when cut. Look and feel like natural breasts due to the cohesive silicone gel material. New generation silicone gel implants are far superior than those used in the past and have a proven track record of safety. Silicone implants have gone through more testing than any other medical device and are the preferred choice for over the muscle implant placement. 
To further ensure the safety, the FDA recommends women have periodic MRI testing to ensure their silicone implants are free from any defects.

#Shaped implants are all #textured and should not rotate when used properly. In my practice, about 20% of the patients benefit from shaped implants. Your Plastic Surgeon needs to measure you and determine the best shape and size of any implants that are used. Any cosmetic #revision has risks of unhappy outcome or other complications. Also, the right implant for the revision is contingent on shape of body and your desired outcome.  Your procedure should always be performed by a #PlasticSurgeon who is board-certified and has a great deal of experience specializing in cosmetic #surgery. You will then greatly improve your chances of getting the result you desire, and, without the need for another revision surgery. It is suggested that you look at before and after photos of the surgeons actual patients, and read patient #reviews. Gathering all of this information will help you make a well-informed decision.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 116 reviews

Changing the Implant is correct, the type doesn't matter.

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Your doctor is correct that doing something different the second time is the right choice. However changing from a saline to silicone implant won't make much difference in your chances of getting a capsular contracture. The contracture is caused by unclear reasons. It isn't just a reaction from your body, or it would have happened on both sides. It isn't just bleeding or infection, because it happens in people with no problems and even many years after surgery.

So, without knowing the cause, you need to do something different. I would agree with changing from saline to silicone. It couldn't hurt. If your implant is subglandular, or on top of the muscle, you should have it moved into a submuscular pocket. I would not recommend the reverse. Your doctor may want to consider textured implants to fool your body to form less of a capsule. It has been less effective under the muscle, but again, it can't hurt.

Changing the size does not matter. You may need a bit of a lift if your skin has stretched significantly. Your risk of a capsule is however greater than 1%. If you have already developed a capsule, you are at a higher risk of forming another capsule. Your risk is probably 4-5% of having a problem in the future. It may be higher, but that is not a reason to hold off on surgery. If you have a painful contracture, have it corrected and massage alot post op.

The rate is higher

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The rate of capsular contracture is much higher than 1% for patients that have had a previous CC.  Some studies suggest it is about 20-30%, and may even be higher.

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

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.