Posts Tagged hardening
I have had a capsulectomy due to capsular contraction, but now it has returned. I want an explant because they are uncomfortable and look unnatural. My doctor said that since the capsulectomy did not resolve the issue, he recommends having an explant and waiting about 6 months to a year. After my body has healed properly, he said that I can get implants again and will not get capsular contraction again. Is this accurate? Am I less likely to get capsular contraction or will I be free of capsular contraction? I’m also looking for a doctor experienced in explants.
The subject of hardened breast implants (Capsular Contracture) comes up frequently as it is the leading cause of long term dissatisfaction with breast implants. If your breasts tend to hurt or look unnatural, you likely have severe encapsulation (Baker Grade III or IV.) When contracture redevelops quickly after capsulectomy (assuming the operation was thorough,) this is worrisome as it may indicate a high tendency for recurrence. The main question when severe contracture is present is whether or not a cause can be identified. Bothersome contracture doesn’t happen to all patients. This kind of reaction is associated with cigarette smoking, bleeding, infection, silicone gel implants, poor soft tissue coverage and radiation exposure as well as a previous history of contracture. Some of these issues can be minimized in an attempt to reduce the tendency for encapsulation. Preventing the problem is the best solution.
While removal of your implants for a time with later replacement might improve the problem, this is not a “slam dunk” nor is it guaranteed to completely solve it. The results vary substantially. Usually removal with a good capsulectomy is the best thing for comfort. Implant replacement at times is thwarted by recurrence of the contracture.
Then again if you leave the implants in place things will not likely improve as you have had a trial of capsulectomy and replacement already. It is true however that a woman who has had her implants removed and not replaced frequently has them put in once again down the road due to appearance issues. This is not invariably the case however. Some women actually like the look of their breasts without implants after capsulectomy and explantation. The results of such surgery vary though.
These cases need to be handled individually and with a fair amount of disclosure before surgery is performed, so that everyone comes out satisfied. I don’t have one treatment that goes for all patients on the issue due to their inherent variability.
John Di Saia MD
Originally posted 2011-05-31 07:30:35.
Beauty and The Breast (a blog that later went offline) blogged on my Silicone Implant Position Post. They placed a picture of a Saline-filled implant explantation specimen with what appeared to be thick capsules seemingly to say “see this happens with saline implants too.” The capsule pictures they showed were kinda low resolution but did not seem to have calcium deposits.
Maybe I need to clarify this a bit. The process of capsular contracture happens with all foreign bodies placed into the body. The body makes a capsule with all breast implants silicone and saline. The question when such a device is placed is not whether it will occur but how can we make it occur to the least extent.
Things that can make capsules worse (generally thicker) include:
(1) Bleeding and/or Trauma
(3) Poor or Thin Soft Tissue Coverage
(5) Radiation therapy
and arguably Silicone Gel.
Now why the Silicone Gel:
First by “Gel” we mean the stuff in the implant container or “shell.” The hard silicone gel “shell” that holds the contents of all breast implants is the same as the cover of other implants such as pacemakers etc. This alone has never been shown to be associated with thick capsules without one of the other things we mentioned above going on as well. When those capsules get thick, they rarely get calcified. This is relative to the “shell’s” solid silicone alone.
Silicone Gel is a non-biological filler put in the “shell” in Silicone Gel implants. It unfortunately does not stay in its container well. When you put Silicone Gel into the “shell,” we find that it weeps right through this “shell” in a process called Silicone Gel “bleed.” This is not the same with Saline-filled and Silicone Gel implants.
It is my belief that this added gel bleed contributes not only to thick capsules, but to the development of calcium deposits that make silicone gel implant capsules harder than any Saline-filled implant capsule. Those are the “glistening white shards” you see in the video from my previous post. So you can get thick capsules with any implant if other things happen, but the calcium deposition seems to be much more of a problem when you add the Silicone Gel. And this makes really hard; uncomfortably hard capsules.
The problem with these observations is that some women have had both Saline-filled and Silicone Gel implants. You never really get all the gel out of there when you remove a pair of implants. The gel as we mentioned weeps into the breast tissue as well. You get most of it out by removing the capsules with the implant. So there are cases of women who have had both types of implants having capsules. It kinda blurs the margin between the two when you are trying to keep track.
I appreciate the gals at Beauty and The Breast posting on this as it showed me that further discussion was needed. Again I am not saying Silicone Gel implants are “bad” and Saline-filled implants are “good.” I am saying that the severity of the local tissue reactions that develop with breast implants tend to be less over time with Saline-filled rather than Silicone Gel implants. This has been the summation of my experience working with them over the last 13 years. When a woman chooses to have breast implants she has to make a choice. This choice has something to do with risk tolerance. If women choose Silicone knowing this, that is of course their choice. I am mostly a Saline-filled breast implant surgeon although I do place some Silicone Gel implants as well.
John Di Saia MD
Originally posted 2008-06-30 07:30:00.
Reader Laura’s Comment:
“After the scares in Europe over the PIP breast implants there seems to be another brand that is just as bad. A rep for Nuffield Health has advised Doctors not to offer patients a kind of breast implants called Silimed and to quarantine existing implants. The implants are reported to have a coating that has been found in previous studies to potentially release a cancer causing toxin into the body over the years. Up to 20,000 woman are reported to have this implant. Are any of these implants available in the US? Do you think they have made it to the US or will anytime in the near future? What safeguards are in place to keep implants like these from getting into the US marketplace? Who are the main manufacturers of implants in the US?”
The manufacturer of the implants, Polytech Health and Aesthetics, based in Dieburg, Germany, says their coating, made of a plastic called micropolyurethane, reduces the risk of a common complication of breast surgery which leads to the formation of lumps around the implant. It supplied evidence to support this claim to the MHRA in 2003. But the regulator concluded the benefit ‘did not outweigh the remote but unquantifiable carcinogenic risk’ and could not recommend the re-introduction of the implants to the UK.
The two main makers of breast implants in the United States are Allergan and Mentor H/S. Silimed has sold implants in the US before but I am pretty sure that their polyurethane coated silicone gel implants were not included.
Polyurethane coated implants were used in the US decades ago in an attempt to deter hardening of the implanted breasts (capsular contracture.) It was debatable as to whether it helped the problem but the coating had a tendency to come off of the implants and get into the patient’s tissues. There were also concerns of carcinogenicity. These coated implants were removed from the US market in 1991.
As I have said before, patients need to be more selective about choosing good qualified plastic surgeons. Good doctors choose implants that are less risky and make educated choices on their patient’s behalf or at the very least inform them of the risks they might be entertaining. Silicone gel implants are more risky as are those from less well known manufacturers.
John Di Saia MD
My trip to Glamourcon was an exploration of sorts. Amongst potential goals was to speak to some models who were OK with their plastic surgery experience and felt free about talking about it. These ladies are rare. Some feel better knowing their interviewer is a plastic surgeon.
I did meet a sweet gal by the name of Cat Cleavage. Cat has been a model and porn star over the years and admittedly has had more than her fair share of plastic surgery. Not all of it has gone so well.
She openly admits to 9 breast implant operations. She has had problems with contracture (breast hardening.) She is a smoker, but has not had silicone gel implants. I did not examine her as we were in the middle of a convention hall. She talks about problem with thinning breast tissue over the implants. Cat is starting to think about going smaller but is hesitant about larger breast lifts for fear of scarring. She has also had soft tissue fillers of the lips including a “knockoff silicone” that caused lumps that she needed removed in part and several facelifts. She has had four surgeons.
We talked in a generic sense about what might be done about her issues. Cases like hers are not easy, but improvements can be made.
John Di Saia MD
Originally posted 2010-11-15 07:30:24.
Looking at the online forums, it seems that the prevailing attitude is that if you are having problems with your saline implants, a switch to silicone gel is the universal cure.
Although I am not in total agreement of the FDA position on the matter, I believe that silicone gel implants pose a long term risk to the patient. In my experience, they tend to harden much more readily than their saline-filled counterparts. The newer cohesive gel types are just that: “new.” There is no long term data showing us how patients implanted with them will do. They are probably better than the older gel implants, but they will leak to some extent and the outcomes of this are not as of yet known.
Hardening in the case of silicone gel frequently involves calcification. Your body deposits calcium inside a scar tissue shell around the implant. It looks like egg shells:
This patient had had silicone gel implants for twenty years before I removed them. The white layer in the picture is calcium.
Saline-filled implants do not tend to do this in the same way or to the same extent.
John Di Saia MD