A Plastic Surgeon on What to Know about Breast Implant Complications

Are there other possible complications of silicone- or water-containing implants?

When anything that gets implanted in a human body, the body recognizes it as foreign and walls it off, so to speak. The capsule tissue contains cells called myofibroblasts and fibroblasts. These cells produce the collagen that forms the matrix of the capsule. Should any bacteria find its way into the capsule space, they can form an entity called biofilm, which is a microscopic layer between the capsule and the breast implant.

A myofibroblast behaves like a little muscle cell and can contract like a muscle. In the condition called capsular contracture, that’s what’s happening. I think it may be inflammation that causes the myofibroblasts to contract and then tighten down around the implant. When the capsule tightens down, it can eventually change the shape of that breast implant. One hypothesis is that bacteria, from an upper respiratory infection, for example, could be seeding the capsule space and causing inflammation and capsular contracture.

Whether or not capsular contracture happens depends on a couple things: the type of implant (whether it’s silicone or saline), the implant surface type (smooth versus textured), and where you’re putting the implant (above or below the muscle). Depending on which study you read, saline implants have a slightly lower rate of capsular contracture than silicone implants, and textured implants have a lower rate of capsular contracture than smooth implants. That was one reason textured implants were developed in the first place. The second reason textured implants were developed was because a textured surface is much less likely to rotate or slide.

My practice for the last decade has really been focused on a lot of revision breast work, such as redoing breast reductions or breast lifts. And I focus on a lot on implant complications, like capsular contracture, implant ruptures, and when the implant may have started in the right place but ends up in the wrong place.