The Biggest Issue in Breast Implants Part 3: Breast Implantation Issues

Judy in Trinidad

How is capsular contracture or hardening of the breast implants treated?

First, as mentioned in the past essay, we attempt to prevent this by encouraging the consumption of fish oil and Vitamin E. These home remedies are not clearly established to prevent capsules, but there is a lot of circumstantial evidence suggesting that they do.

Second, if you have a capsule, there are various remedies, and one of the things that has been thought to work is a medicine for lung disease called Accolate, or another related medicine called Singulair. These brand-name medicines are commonly used by lung doctors to improve lung functioning in certain kinds of asthmatic and other conditions. They have a very small statistical rate of some serious problem, so be sure to talk to your doctor about these before taking the medicines. In any case, they're expensive and they need to be taken for four to six months in order to be effective. The earlier you catch your capsule, in other words, the softer the breast is before starting the medicine, the better chance you have of correcting the problem with a medication.

We also increase the fish oil to a higher dose, although as stated before, this is not clearly known to be effective. We have seen interesting cases in which a person who stops taking their Vitamin E or fish oil and develops a capsule within a month, but of course, this doesn't prove anything for sure.

Surgery for capsular contracture is problematic, because the chances of the problem coming back are very, very high after most any surgery. The traditional approaches include removal of the capsule, which sometimes is difficult, especially under the muscle, and replacement of the implant in a different plane. This means that if the implant was above the muscle, you put it below the muscle; and if it was below the muscle, you put it above the muscle in the secondary operation. The chances of a return of the hardening of the breast after these surgeries is a disappointing nearly 50 percent.

Unfortunately, the Allergan study, which encompassed many, many thousands of women with breast implants and silicone gel implants, had a secondary operation rate of about one in three after seven years. This means that you must not view these things as a permanent solution to small breasts unless you're lucky.

Judy, my wife, has had her implants for about 15 years and has never had any problem except for a slight firming on one side, so she might be the exception rather than the rule.

Best of luck, and if you get breast implants, be sure you have a good surgeon who will be happy to follow you for any problems afterwards.

The Biggest Issue in Breast Implants Part 2: The Advantages and Disadvantages of Various Breast Implant Techniques

Seattle Port at Night 2

Part 1 covered some of the aspects of above versus below-the-muscle implant placement. One more note about this issue: There was a large-scale study over 20 years ago that showed that with silicone implants that there was a higher capsule or hardening rate with over-the-muscle implants. Subsequent studies have not shown this to be true, so even though this remains as an urban legend, it probably has not been verified. It probably isn't the case.

This brings us to the subject of this essay, hardening or firming of the breast implants or "capsular contracture." Capsular contracture is the most likely complication after breast implantation, and many studies show that rates are about 5 percent or 1 in 20. When capsular contracture occurs, the breast implants become hard and sometimes progressively so, to such an extent that the women can't stand it and want them removed. Most capsules have no significant health impact, but they can be uncomfortable and be cosmetically unacceptable.

The things we try to do to avoid a capsule after the breast implant surgery are threefold.

First, we encourage the use of good-fitting bras (this also helps decrease problems with the implants descending).

Second, we encourage postoperative patients to take fish oil. Fish oil is an anti-inflammatory and we think that it decreases the capsule formation, although this has never been formally studied and may be another urban legend.

Third, Vitamin E at doses of 400/800 International Units a day also helps decrease the chance of a capsule formation.

No one really knows what causes these complications, but certainly if you have some inflammation or an infection or extra blood around the implant, these all typically do increase the risk of capsule formation. But most capsules are of unknown cause, and some women just seem to be capsule-formers. It's possible that the breast ducts which connect with the outside in some women are colonized or infected with bacteria and this may contribute to capsule formation, but this is unclear.

Certainly if you're lactating, your chances of a capsule are much higher, and so for this reason we recommend that you not consider breast implantation for a full three months after having your baby (if you do not breast feed) or after stopping breast-feeding.

The Biggest Issue in Breast Implants: A 3-Part Series

Pasadena's Natural Beauty

 Part 1: By far the most important choice you will make in your pursuit of bigger breasts is whether to put the implant above or below the muscle. The muscle is a wildcard that produces many effects, not all of them good. Understanding all of these options and possibilities is very important. 

We recently took the Sports Illustrated swimwear, swimsuit model edition, and analyzed the problems with the women's breast implants. Many of the under-the-muscle placements had resulted in the implant being pushed out toward the side and down. The girls in the Sports Illustrated photographs were often holding their breasts toward the middle, and many times the implant had dropped or been forced down lower than it might naturally have done so by the muscle action. 

Under-the-muscle implants are supposed to produce a more natural curve in the upper part of the breast area, and perhaps they do for a while. However, eventually most "under the muscle" implants get pushed down so the muscle is no longer really covering them. 

Of course, it's possible and even likely that over-the-muscle implants droop also, unless they're protected by a good-quality bra most of the time. These implants, however, tend to sag straight down. 

Efforts to repair problems like these are relatively hazardous compared to the initial implant surgery. The medical journals are full of reports of nipple areolar area death and a higher infection rate and other problems due to attempts to improve breast implants. 

One particular article I show the patients who want surgery because their breasts have stretched out, and this article shows in living color nipple areolar complex or nipple areolar area skin death and loss of the nipple and areola. 

Even though breast implants have problems, they are still the most popular and the highest satisfaction cosmetic surgery we have. Women who improve their bustline often feel much more confident and are able to perform at a higher level in many ways.