Richard V. Dowden, M.D., C.M., F.A.C.S.

Certified by the American Board of Plastic Surgery

Cosmetic and Plastic Surgery, Inc.
6770 Mayfield Road, Suite 410
(Mayfield Heights) Cleveland, Ohio 44124
(440) 449-7470

Answers to Frequently Asked Questions about
breast enlargement:

Can salt-water filled implants harden like the silicone-filled ones?

The implants themselves do not actually harden, but they sometimes can come to feel hard. The reason is that any implanted medical device, from pacemakers to hip joints, will cause the body to form a scar tissue layer around it, and that happens with breast implants also, whether they are filled with silicone or with salt-water. In some ways, that scar tissue is helpful: it holds the implants in position, and it affords some protection against damage to the implant from trauma.

But in some patients, that scar tissue layer may tighten, which can make the implant feel like it is hard. The technical term is Capsular Contracture ("CC"). If that happens, the breast may feel and look unacceptably hard, or may even get displaced slightly out of position, and need an operation to soften it, and approximately 5% of women need such surgery (for silicone gel implants it is higher, about 15%). There is no way to tell in advance who is likely to get hardening and who is not. It is even possible to harden on only one side. Getting hardening does not mean that the implants must be removed.

Prevention To help prevent hardening, the patient may be advised to take Vitamin E 100 iu each morning and again at night, and MSM 1000mg each morning and again at night, both of which somehow help prevent contracture. The mechanism for these is not fully understood, but the effectiveness was discovered and has been confirmed. The main preventive against contracture is that the implants need to be massaged or compressed for a few minutes every day. If the implants are in front of the muscle, the patient will deliberately compress them; if the implants are under the muscle then the muscle will automatically do the massage. Whichever are the options chosen, the chance of needing surgery for hardening remains about 5% longterm.

Most hardening is evident within the first few years, but it can occur much later. A strange thing is that many of the cases of late hardening occurred right after the woman had dental cleaning without taking protective antibiotics prior to having the cleaning done.

Because surgery for hardening is often a larger operation than putting the implants in originally, it is important for patients to keep their long-term postoperative appointments. If hardening starts to occur, and it is detected early, then certain treatments can be started to try to avoid the need for an operation. One of these treatments, strangely, is for the patient to take an asthma pill (Accolate or Singulair) daily for three months, with about a 75% chance of avoiding operation. Another treatment is for her to use a plastic clamp-like device (Sta-Sof) on her breast for about 15 minutes several times a day for a few months. This sounds cumbersome, but it is far better than going through a large operation. Unfortunately, these clamps are no longer being manufactured, so they are unavailable at this time.

There is an erroneous folklore belief that re-operation carries an increased chance of postoperative problems or complications. In particular, there is a mistaken belief that the chance of capsular contracture is higher after any kind of re-operation. That is only correct if the re-operation is done for the purpose of treating established capsular contracture. In that case, with each re-operation the chance of capsular contracture returning is greater, not because the re-operation is causing it, but rather because it is being demonstrated that the patient is more prone to the capsular hardening problem. Here are the approximate statistics, starting out with 10,000 women getting breast augmentation with saline implants (silicone-filled implants have a higher chance of capsular contracture and are not being discussed here):

Say 10,000 women have augmentation, with a 95% chance they will never harden.
  But 5% will harden, that is 500 women who will be re-operated.
    So 500 women are re-operated, with a 90% chance they will not re-harden.
	  But 10% (50 women) will re-harden.
	    So 50 women are re-operated, with an 80% chance they will not re-harden.
		  But 20% (10 women) will re-harden.
		    So 10 women are re-operated, with a 60% chance they will not re-harden.
              But 40% (4 women) will re-harden.
			    If those 4 are re-operated, they are highly likely to re-harden.
So out of 10,000 women, only 4 would be unable to achieve soft breasts.

But for most re-operations, such as replacement for deflation, or change to a larger or smaller size of implants, re-operation carries an even lower chance of complications than the original augmentation. It is important to be clear on this point.

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6770 Mayfield Road, Suite 410
(Mayfield Heights) Cleveland, Ohio 44124
(440) 449-7470

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