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!

A: 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 implants.

The exact numbers depend on the surgeon’s technique to some extent also, so it’s important to know if your surgeon bathes the implants in any antibiotics prior to insertion, if he/she changes gloves, etc.

In general an implant placed under (behind) the muscle has lower rates of capsular contracture than those place in front of the muscle (subglandular).

Silicone implants used to have higher capsular contracture rates, but now with the newer generation cohesive gel implants, the rates are comparable to saline; some studies even suggest they are lower than saline.

Please discuss this with your plastic surgeon prior to selecting your breast implants.

Best wishes,

Dr. Bruno