The type of implant and placement effect rates of contracture. Implants under the muscle have a 2-5% risk versus 20-40% above. Texture has shown beneficial in some studies and equal to smooth in others. Best of luck.
Capsular contracture is quite rare when implants are placed under the muscle. In my 15 years of practice, always using the sub muscular technique, I've only had 2 cases of capsular contracture when I performed the primary augmentation.Long term studies do show that when the implant is placed on top of the muscle (sub glandular position) One in 10 women will develop a capsular contracture within the first five years after their surgery. More importantly, implants on top of the muscle can interfere with mammography, rendering up to 30% of a patient's breast tissue unable to be visualized on routine mammograms.
When we use implants we extreme the care of the sterile technique for not letting any foreign matter to get into the plane where we are placing the implants, which is what the Keller Funnel is about.
But the kind of implants to be use and the plane in which they are going to be placed are essential to avoid capsular contracture. For example saline and smooth surface implants, and ver the muscles implants have high percentage of developing capsular contracture.
Today with the Sientra Implants placed under the pectoral muscles statistics for capsular contracture are very very low. This are 5th generation Silicone Cohesive Gel Texturized Cover High Profile Implants. Sientra is the branding name of this implants in US, in DR they are in the market long before in the US as Silimed, Brazilian made FDA approved.
The incidence of contracture in my experience with this implants is under 1%.
The rate of significant capsular contracture with the new cohesive gel implamts in the most recent study is 4.3% which is a huge improvement over the 30-40% with the old implants in the 1970's.
According to the FDA 23.7% of breast implant patients have a second operation in 10 years. That means that the majority, over 70% do not.
Thank you for your excellent question, and I can understand your apprehension. Capsular contracture takes place in all breast augmentation cases, and is a process by which the body places scar tissue around the implant, "walling if off" from the rest of the body. Contracture is graded on a scale of 1-4, where grade 1 indicates a breast that looks and feels like a normal breast, grade 2 indicates a breast that feels firm, but has no visible alterations/changes, grade 3 feels firm and looks altered, and grade 4 has associated chest pain. The severity of the contracture largely determines if any additional surgery is needed to correct it (normally grades 3 and 4). Though there is no certainty as to what causes capsular contracture, the leading thought is that contamination of the implant with bacteria may predispose to higher grades. This is the reason that surgeons use minimal touch techniques with breast implants to lower this contamination risk. Though contracture occurs in all cases, the vast majority of implants do not experience the complications of the higher grades. Hope that this helps.
While at one time this was a common problem, thankfully, capsular contracture, in most surgeons recent experience is rare complication. My personal experience mirrors that of Dr. Sieveking, and others. The use of modern devices and techniques have made this a less than one percent type of problem. Plastic surgeons face this problem sometimes after implant reconstruction used after mastectomy, especially in irradiated patients, but rarely in augmentation patients.
Capsular contractures are a greater risk when implants are placed above the chest muscle rather than below it. I think this is due to two things - first, when placed under the muscle, your daily activity using the chest muscle causes this muscle to massage the implant below it. More importantly, however, I believe that significant capsular contractures occur in response to bacteria. There is an abundance of bacteria living within the breast tissue. By placing the implants below the muscle, the muscle forms a barrier between the implants below the muscle and the breast tissue above where the bacteria live. Since I started placing implants below the muscle 15-18 years ago, I have almost eliminated capsular contractures from my practice. I rarely see them anymore. So, to sum up, from my perspective, if you are a good candidate, then placing the implants below the muscle is your best defense against forming capsular contractures.
most patients don't get any significant capsular contracture. best to place the implant under your chest muscle. certainly, there are no guarantees or any way to test if you would make a strong capsule. most women do think it is worth it.
the new technology involved in gel implants, the data that capsular contracture above and below the muscle is essentially the same. Bacteria are thought to
be one cause for a contractor. Therefore anything to minimize exposure to
bacteria during the case helps minimize capsular contracture. I prefer an
inframammary fold incision to a periareolar fold incision for this very reason.
Yes, it can happen. Despite all the precautions, it still seems to happen about 1-2% of the time. Small implants under the muscle have the lowest risk. Women who go too big right off the bat are in for a lot of revisions in the future -- so don't do that! Certainly wait until after your last child and if you really want it, go for it! I have patients who have had implants for 15+ years with no issues. Good luck!