Below is a recent question from a patient 15 years post breast augmentation. She asked a very good question and it deserves answering, but I also want to get it out to all of my patients. It turns out that studies done by Allergan and Mentor separately show that, across the country, 7% of patients get capsular contracture (hard breasts) within the first 3 years of surgery, therefore probably related to the surgery. Another 8% of patients get capsular contracture between 3 and 8 years post breast augmentation. This second group of patients who get capsular contracture is related to causative situations only very indirectly associated with the breast augmentation surgical event.
The #1 cause of capsular contractures in this group was the dental visit. Individuals who care enough about themselves and their appearance to get breast augmentations also care about their oral health as well. Therefore, these individuals are the ones who get their teeth cleaned on a regular basis and their cavities taken care of immediately when they arise. The human mouth has some of the nastiest bacteria in the world and I have heard it said that a human bite is much more dangerous than an animal bite. Therefore, when one gets blood in his or her mouth during a dental visit, there is a route of entry for oral bacteria to get into one’s system. Our immune system has basically one way to deal with invaders into our bodies, and that mechanism is to wall off the invader. That happens around artificial hips, pacemakers, breast implants, etc. The walls around these foreign bodies are called capsules. If these capsules are thin and pliable, there is no pain on walking if you have an artificial hip or knee and there are no hard breasts if you had a breast augmentation. However, if after these capsules form, there is a second invader such as oral flora, the body may depending on several factors start walling off your breast implants more, leading to a hard breast or pain on ambulation if an artificial hips is present.
The way to inhibit this second and thicker capsule around a breast implant is to eliminate for a very short period time the oral flora from your mouth by taking antibiotics one hour before the dental visit. This wipes out all oral flora for several hours, and when you get your teeth cleaned and/or a tooth drilled with a rubber dam in your mouth and you get blood in your mouth, there is no bacteria to get into your system, and therefore your immune system is not triggered to wall off foreign bodies (i.e. to turn your breasts hard).
My patient’s question was, “since it has been 15 years since my breast augmentation, can I stop taking antibiotics before the dentist”. My answer to this would be, I don’t think the problem ever goes away, and it is such a small amount of antibiotic and one goes to the dentist routinely but sporatically, and therefore the antibiotic is cheap insurance to decrease the chance of uncomfortable hard breasts and/or a second surgery which can be avoided.
I am not an infectious disease doctor, nor am I an immunologist, nor am I a researcher. I am merely a “boots on the ground” every day sort of cosmetic plastic surgeon, and I can tell you from my own 36 years of experience that my patients who follow the above recommendations have much fewer redo surgeries and many few