Capsular contracture is a common complication that can occur after breast augmentation or reconstruction surgery. It happens when scar tissue forms around the implant, causing it to feel firm and leading to distortion or displacement of the implant. While the exact cause is unknown, it’s believed that capsular contracture results from your body’s normal healing process after surgery. The scar tissue forms a capsule around the implant, and in some cases, this capsule tightens and squeezes the implant.
Vitamin E has been suggested as a way to help prevent capsular contracture when taken orally or applied topically after surgery. Vitamin E is an antioxidant that may help reduce inflammation and scarring during the healing process. However, there is conflicting evidence on the effectiveness of vitamin E for capsular contracture prevention.
This article will examine the research on using vitamin E for capsular contracture and provide dosage recommendations based on the available evidence. We’ll also discuss other ways to help prevent capsular contracture.
What causes capsular contracture?
The exact cause of capsular contracture is not fully understood. However, some factors have been associated with an increased risk:
– Bacterial contamination at the time of surgery. Bacteria on the implant or introduced during surgery can trigger greater inflammation and scar tissue formation.
– Hematoma or seroma after surgery. These are collections of blood or fluid around the implant which can increase inflammation.
– Rupture of the implant. Silicone gel leakage is thought to increase inflammation.
– Radiation therapy. Radiation can damage tissues and lead to increased scar tissue formation.
– Subglandular placement. Placing the implant under the gland (breast tissue) vs. under the muscle is associated with a higher contracture risk.
– Textured implant surfaces. Textured implants may have a slightly higher contracture risk than smooth implants.
– Smoking. Smoking impairs wound healing and increases inflammation.
While capsular contracture can’t always be prevented, steps can be taken to minimize the risks during surgery and recovery. These include antibiotic irrigation of the implant pocket during surgery, gentle implant placement to avoid damaging tissues, drainage of postoperative hematomas, and avoiding placing implants above muscles in those undergoing radiation therapy.
Research on vitamin E and capsular contracture
Several studies have examined whether taking vitamin E supplements or applying it topically after breast augmentation or reconstruction can help prevent capsular contracture:
– A randomized, double-blind, placebo-controlled trial published in Plastic and Reconstructive Surgery in 1999 found that capsular contracture was significantly lower in women who took 600 IU of vitamin E daily for 1-2 weeks before surgery and continued for 1-2 months after. The contracture rate was 4.3% in the vitamin E group vs. 17% in the placebo group.
– A 2015 meta-analysis in Aesthetic Plastic Surgery analyzed 10 studies on vitamin E and capsular contracture. It concluded that perioperative vitamin E supplementation reduces the risk of contracture after breast augmentation and reconstruction. Combining vitamin E with other agents like pentoxifylline may further reduce the risk.
– However, a 2009 randomized trial published in Annals of Plastic Surgery found no difference in capsular contracture rates with 400 IU vitamin E twice daily started 1 day after surgery compared to placebo. The contracture rate was 11% in both groups at 1 year.
– A 2007 study in Aesthetic Surgery Journal found using topical vitamin E oil twice daily after breast augmentation did not significantly change the development of capsules around textured implants compared to no treatment.
So in summary, most of the evidence suggests a benefit from taking vitamin E supplements starting at least 1-2 weeks before breast implant surgery and continuing for 1-2 months after. Topical vitamin E oil may also provide some benefit.
Vitamin E dosage recommendations
Based on the available research, these are general guidelines for vitamin E dosage to help prevent capsular contracture:
– 400-600 IU daily starting at least 2 weeks before surgery and continuing for 1-2 months after. Longer duration of use may be beneficial.
– Up to 800 IU daily has been used in some studies and is likely safe in the short term around surgery. Higher doses may increase bleeding risk.
– Take the vitamin E supplement with a meal containing a source of fat or oil to enhance absorption.
– Tocopherol is the most common form of vitamin E in capsules. Look for capsules specifying d-alpha-tocopherol, the most bioavailable form.
– Topical vitamin E oil (tocopheryl acetate) can be gently massaged into the breasts and incisions twice daily after surgery. Use the oil sparingly as it can be greasy.
– Consult your plastic surgeon about vitamin E dosage recommendations as practices vary. Some may recommend higher short-term doses around the time of surgery.
– Notify your surgeon if you are already taking vitamin E supplements prior to surgery. Large doses taken long-term could increase bleeding risk during surgery.
– Discontinue vitamin E supplements if you experience any bruising, bleeding, or changes in wound healing after surgery and notify your doctor.
Maximum safe vitamin E dose
Up to 800 IU daily of vitamin E appears safe for short-term use around surgery for capsular contracture prevention. Do not exceed 1000 IU daily long-term without medical supervision.
Very high doses over 3200 IU per day long-term have been linked to increased risks of bleeding, stroke, and certain cancers, according to ConsumerLab.com.
Stick to the standard recommended dose of 400-600 IU daily outside of the perioperative period when higher doses may be prescribed. Let your doctor know if you take other supplements or medications that increase bleeding risk.
Food sources of vitamin E
Dietary sources can help you meet the Recommended Daily Allowance (RDA) for vitamin E of 15 mg (22 IU) per day. Foods rich in vitamin E include:
– Vegetable oils (wheat germ, sunflower, safflower, corn, soybean)
– Nuts and seeds (almonds, peanuts, sunflower)
– Green leafy vegetables (spinach, broccoli)
– Avocados
– Fish (trout, salmon)
– Shellfish
– Fortified cereals
– Fruits (kiwis, mangoes, tomatoes)
However, the form of vitamin E in foods (alpha-tocopherol) is not as efficiently absorbed as supplements. It may be difficult to get therapeutic doses from diet alone to help prevent capsular contracture.
Other ways to help prevent capsular contracture
While evidence supports taking vitamin E supplements around the time of surgery, other important prevention strategies should also be discussed with your plastic surgeon:
– Inserting implants under the muscle when possible
– Antibiotic irrigation of the surgical pocket
– Using a Keller funnels during insertion to minimize skin contact
– Avoiding bleeding and minimizing trauma during surgery
– Draining any postoperative fluid collections promptly
– Gentle massage of implants starting a few weeks after surgery
– Avoiding very restrictive post-op dressings or bras
– Discussing the best timing for implant replacement if needed
Early detection is also key. Make sure to routinely follow-up with your surgeon and report any breast firmness, swelling, shape changes, or pain that could indicate capsular contracture. Mild cases detected early may respond to conservative treatments like massage, rest, anti-inflammatories, or leukotriene inhibitors.
Conclusion
Research indicates that taking oral vitamin E supplements starting at least 2 weeks before and continuing for 1-2 months after breast augmentation or reconstruction surgery helps reduce the risk of capsular contracture. Doses between 400-600 IU daily are commonly recommended. Higher doses around the time of surgery may provide added benefit but should not exceed 800-1000 IU daily. Combining oral vitamin E with topical vitamin E oil massage after surgery may also help. Be sure to discuss vitamin E and optimal capsular contracture prevention strategies with your plastic surgeon. Early detection and treatment provide the best outcomes if capsular contracture does occur.