Breast implants, saline or silicone, are foreign bodies, which in general are inert and after the initial healing phase, unreactive to the human body. The body does recognize breast implants as foreign when they are placed during a breast augmentation, and it does form a thin capsule around the implant. This thin capsule protects the breast implant from further detection and inflammation from the body. The shell of the implant also protects the inner substance from the body and from leakage.
The first generation silicone breast implants were designed to rupture early and relied on this natural capsule for the maintenance of shape of the implant.
These days, the new 5th generation silicone breast implants (Highly Cohesive or Gummy Bear Breast implants) are more of a solid silicone gel unit without a liquid phase, which hold their shape if ruptured, and decreases the amount of silicone dispersion and/or exposure to the local tissue.
The body’s natural response to breast implants helps to maintain implant position and consistency.
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A capsular contracture, or scarring around the breast implant, can be increased in intensity with:
- Bleeding: Blood is inflammatory and incites a reaction leading to scar tissue. Undrained breast hematomas are a set up for early capsular contractures.
- Infection: Recent literature suggests that biofilms created by latent bacteria are an important contributor to capsular contracture. The use of anti-biotic irrigation, betadiene, and careful surgical technique can all limit biofilm on the breast implant.
- Leakage/Rupture: A silicone rupture is inflammatory a can cause a dense reaction around the breast implant.
Silicone leakage can be more inflammatory than saline. If a saline implant ruptures or deflates, the saline is resorbed. When older silicone implants rupture, the silicone disperses and can cause an inflammatory reaction. This inflammation around the silicone breast implant can lead to scarring and a capsular contracture. A capsular contracture can cause hardening and rippling of the implant, as well as breast implant malposition and breast deformity. A breast implant that is hard, painful, rippled and high riding is a sign of capsular contracture.
Early capsular contracture (within 3 years of placement) can also be related to bleeding and low-grade infection around the implant. This makes the risk of scarring around the fourth generation silicone and saline breast implants equivalent and equals about 7 to 10% after 10 years. The risk of breast implant rupture is relatively equal and is about 1% per year, but if a breast implant ruptures the scarring is more intense with silicone. A new or worsening capsular contracture can be a sign of a silicone breast implant rupture, but with saline breast implant rupture, the immediate loss of volume is the usual problem.
The remedy for a breast implant capsular contracture may include:
- Removing the breast capsule called a breast capsulectomy
- Changing the breast implants to a 5th generation breast implant
- Changing the implant pocket to a sub-pectoral plane
- Changing the implant shell to a textured breast implant
- Ultrasound energy and medications (steroids and Singular) have been debated as helpful
Most early capsular contractures can be prevented with proper operative technique, including anti-biotic irrigation and a bloodless breast implant pocket. Placement of the breast implant under the muscle can also help decrease the rate of capsular contracture.
In general, breast implant rupture is rare and breast implants do not need to be changed every 10 years. Breast implants only need to changed when there is a problem, such as breast implant rupture or hardness, but more commonly for breast implant size.
Dr. Trussler in his Austin Texas plastic surgery office will review the risks of breast implants and will review the benefits of breast implants to help guide the decision for implant placement during breast enhancement and breast augmentation. Dr. Trussler can help develop a treatment plan for secondary breast implant surgery, after rupture or for capsular contracture.