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.