Breast Implants Placement and Likelihood of Capsular Contracture

asked 2 years ago by Rita_ in San Francisco
Latest answer by Michael Law, MD
Question viewed 1,147 times
Tags: breasts, female, saline implants, silicone implant, capsular contracture, gummy, submuscular, subpectoral

Could you please rank the following (from highest to lowest) in terms of potential to get capsular contracture: subfascial cohesive silicone gel (gummy bear), subpectoral (not fully submuscular) cohesive silicone gel, subpectoral (not fully submuscular) saline?

Please note that by subpectoral breast implants, I'm not referring to "fully submuscular", I'm referring to upper half of implant is under pectoral muscle, whereas lower half of the implant is not covered by muscle. Thank you!

11 answers to Breast Implants Placement and Likelihood of Capsular Contracture

Preventing Capsular Contracture

Because of a number of techniques I use during breast augmentation surgery that are outlined below, I see very few capsular contractures in my breast augmentation patients. However, the reality is that if you are a breast augmentation patient with a capsular contracture, the incidence - at least to you - feels like 100%. A well-established capsular contracture can be corrected, but doing so involves a return to the operating room, removing and discarding the implant, removing or excluding... more

Michael Law, MD
Raleigh-Durham Plastic Surgeon

michaellawmd.com

Breast Implants Placement and Likelihood of Capsular Contracture

Although traditionally I would have said subpectoral saline, I was made aware of some recent data that suggest subpectoral silicone are prone to less capsular contracture. I am not a fan opf subfascial nor total submuscular (unless for breast reconstruction)

Otto Joseph Placik, MD
Chicago Plastic Surgeon

Breast implants and capsular contracture

Capsular contracture is the term for excessive or thick scar tissue which can form around breast implants. This occurs in about 10% of breast implants and can result in a very hard feeling breast and occasionally a distorted appearing implant. The location of the implant has been studied and implants placed subpectorally have a tendency to have lower rates of capsular contracture. Also, cohesive gel implants ("gummy bear") have a lower rate than traditional silicone or saline... more

William Bruno, MD
Beverly Hills Plastic Surgeon

Risks of capsular contracture

You have listed them already from highest to lowest - above the muscle anything, below the muscle gel, below the muscle saline. Gels are more than salines but only by a few percent.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon

Breast Implants and Capsular Contracture

Capsular contracture is not completely understood as of today, but the rates have decreased significantly over the years. Placing the implants under the muscle - whether saline or silicone or total or partial muscle coverage - has provided the most amount of improvement in the rate of capsular contracture. Textured implants have also been shown to have a lower rate of capsular contracture. Beyond these two points you will have varying opinions depending on the surgeon. Many techniques used... more

Bahram Ghaderi, MD
Chicago Plastic Surgeon

Breast augmentation, silicone implants, breast capsules

Dear Rita, You ask a very good question...the difficult ones are the best. As you can see, there are multiple answers but none well substantiated or absolutely conclusive. The choice of implant and position of the implant is best determined by the result you are looking for and the risks you wish to undertake. The risk of capsular contracture is the hardest to put a fixed number on and should not be the major determining factor.

Trevor M. Born, MD
Toronto Plastic Surgeon

Capsule contracture is a risk for all types of breast augmentation

The risks of a complication after breast augmentation are very small, and the risks can be reduced by a well experienced and qualified surgeon. Capsule contracture is one risk however that has eluded our understanding despite a considerable amount or research dedicated to the cause and treatment. Capsule contracture is a tightening of the natural scar which forms around all breast implants which causes the implant to become firm and round up. The scar can become tender and distort the shape... more

Peter E. Johnson, MD
Chicago Plastic Surgeon

www.peterejohnsonmd.com

Capsular contracture

Rates reported for capsular contracture vary from implant company to implant company and from location of implant as well as texturing. Some studies contradict others. Your best bet is to go in a partial submuscular plane.

Steven Wallach, MD
Manhattan Plastic Surgeon

That being said

CC tends to be lowest under the muscle vs subglandular (I don't know about subfascial). Silicone tends to have higher cc rate than saline. Texture tends to reduce cc above muscle. There you have it.

Scott E. Kasden, MD
Dallas Plastic Surgeon

Capsular contracture rates

Everyone's experience differs but statistically, here is a list from greatest chance of capsular contracture to least: Below the fascia + gel below the fascia + saline Below the muscle + gel below the muscle + saline

John P. Stratis, MD
Harrisburg Plastic Surgeon

Different capsular contractures

Rita, It almost sounds like you have been given too many opinions. While there is a published body of literature for each of those options, you should realize that each surgeon has their own rate of capsular contracture using their particular technique. I would consult with a couple of surgeons and ask what their reoperation rate is within 6 months, 1 year and 5 years. We all know those numbers, or at least an approximation. There is a lot of dogma out there one way or another, but ,... more