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. 

Fish Oil Is Just Fantastic Stuff, or: Everything You Wanted To Know About Fish Oil but Were Afraid To Ask

Fish oil has been shown in studies to be an excellent anti-inflammatory. It actually has been used for rheumatoid arthritis to decrease inflammation and pain, and it really works as been proved by scientific study. We use it to attempt to decrease breast firmness after breast implantation, which is the most common complication. Capsular contracture or breast firmness occurs in at least 5% of all breast implants and it is a very aggravating problem for both surgeon and patient. It’s our belief that taking fish oil in reasonably large doses, perhaps a teaspoon a day or more of the liquid fish oil (the equivalent of five of those large 1g pills) can be very useful. The best fish oil is refined fish oil which has had the mercury removed. We recommend Nordic Naturals, Carlson, or Eskimo brand fish oil. Nordic Naturals has the biggest reputation, but it may be more expensive. Buy oils online because they are costly. Nordic Naturals is available in several grades. It is important to become knowledgeable about active components in the fish oil and consider buying the more expensive types. We use larger doses at times to combat capsular contracture.

Fish oil is also good for certain kinds of heart problems, and is heavily recommended for people with high triglycerides, which is part of the cholesterol problem. Dr. Yoho takes fish oil every day for an arthritic ankle and so he is certainly an advocate himself.