How much smaller could I go without complicating things and will the cc come back?

Good morning,
You can certainly go down in size, but given your history I would do everything possible to reduce the recurrence risk- I would put them back under the muscle, place a drain for five days postop, have you take Vitamin E and singulair, and add a sheet of Strattice mesh on each side.

I would not recommend using the same pocket but place smaller implants retro-pectoral. Textured implants have a high risk for capsular contracture.

Best Wishes,

Gary Horndeski, M.D.

Dear Luminous8667,
capsular contracture happens. In fact, every implant has a capsule form around it, its just a certain percentage develop thick capsules. There is a lot we don't know about it actually. Some think that bacteria that gets on the implant during insertion can increase the risk. Thats why we use a Keller Funnel in our practice to reduce that possibility. Our capsular contracture rate is less than 2% because we use a keller funnel as well as meticulous operating room techniques.If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

You might want to consider going down to 225 cc's and asking to be placed on Accolate prior and after surgery.

Dear Luminous,
I must not second guess your plastic surgeon as we all have different techniques to most surgeries. I can only tell you the options I would suggest to a patient with your history.
Number one, yes, I always replace the implants when a CC is present...there may be a Biofilm which causes another re-occurrence.
Two, I prefer submuscular as there is a lower incidence of capsular contracture.
Three, a total capsulectomy is paramount.
Four, consider using an ADM (Acellular Dermal Matrix...ADM) in patients with recurrent CC
Five, Intraoperative antibiotics and irrigation and post operative oral antibiotics (not really indicated but I still use them).
The use of textured implants is physician preference. The size is up to you...if too large, drop by a minimum of 50cc's.
Best wishes,
Dr. Taranow

I 100% DO NOT recommend using textured implants! Either seek additional in person or virtual consults with private practice boarded PSs or exchange to smooth implants using capsulectomy or capsulotomy with drains.

Textured will not help. You should at least switch to under the muscle next time for less CC risk. New implants, antibiotic washes, Keller funnel, drains. Some also recommend ADMs.