Q: Dr. Eppley, I am interested in breast augmentation surgery and am having trouble deciding between saline vs silicone implants. I know there are numerous differences between them but one specific question I have is about capsular contracture. Does silicone implants lead to a higher rate of capsular contracture problems than saline implants?
A: One of the risks of breast augmentation surgery is capsular contracture. Capsular contracture is the result of excessive scar tissue forming around the implant. Then like a shrink wrap, it tightens around the implant causing it to feel more firm and can also distort the shape and position of the implant.
Historically silicone gel implants were associated with a higher rate of capsular contracture problems. This occurred because the implant allowed for some of the gel material to get through and out into the breast tissue (gel bleed) leading to the soft tissue reaction known as capsular contracture. In addition there was a moderately high rate of silicone implant rupture which exposed a lot of the gel material to the breast tissues. By comparison, today’s newer silicone gel implants do not have any significant gel bleed and a much lower rate of implant rupture. (less than 1% in the first five years for one manufacturer) Thus, silicone gel breast implants of 2014 are much improved designs over those used in 1989 with a much lower rate of capsular contracture.
The other issue that has led to a dramatic drop in capsular contracture problems over the past two decades has been the change in implant position. Today the vast majority of breast implants are placed in a partial submuscular (dual plane) position. Decades ago it was far more common for implants to be placed above the muscle (subglandular) position. Submuscular breast implants have a known lower risk of capsular contracture rate.
While the risk of capsular contracture always exist with any type of breast implant, it is a very low risk today with the use of either silicone gel or saline implants placed in either a total submuscular or dual plane pocket position.
Dr. Barry Eppley
Q: My initial breast augmentation was over ten years ago. Two years later, my left breast implant suddenly ruptured. I have had my current saline Mentor Round textured implants in since then and have recently noticed some slight soreness and what seems to be a section that is possibly hardening in the center, all of this is in the left breast again. I do not want to have revision surgery if it is not necessary at this point. I realize that I will again as I am only 35. I am not against it if it is recomended now,I just want to prolong the life of my implants as long as possible. I have read that there are some asthma medications that have been used to treat early stages of capsular contracture with some success. I would like advice on treatment, either trying out the asthma medication or revision surgery or waiting it out to see. I really need advice on what is needed in my situation, an educated opinion would be greatly appreciated. I look to you because your video says you do not believe in selling the surgery, you listen and help clients make informed decisions. That is exactly what I need right now. Thank you very much.
A: Capsular contracture is far less frequent today due to improved implants and the general trend of placing the breast implant under the pectoralis muscle. Even when it was far more prevalent, what causes this excessive scarring and potential breast distortion is not well understood. When medical conditions are not well understood that usually means the treatment(s) for it does not work that well either. Capsular contraction treatment consist only of release and excision (surgery) or a drug medication. The use of Singular, an asthma medication, has been reported to have some success with preventing recurrent capsular contracture. These reports are largely anectodal and are not the result of information of a controlled clinical trial nor is it FDA-approved for this use. From those that report some success with it, it is in the use after a capsulotomy or capsule excision and is given with the intent of prevention. I am not aware that it has any effect on an ongoing or pre-exiting capsular contracture.
Because Singular is expensive and unproven in established or progressive capsular contracture, I would not recommend its use in your case. If the capsular contracture is significant, then surgery should be performed. If it is only minor, which it sounds like, then I would wait it out and see if it becomes more severe.
Dr. Barry Eppley