Ask a doctor

Bottoming out or Capsular Contracture After Revision?

105lbs 5"5'. First BA in April of 07' I had elected to go with 350cc saline through the belly button, the results were beautiful for about 8 months when I noticed hardening of the right breast.It was obvious that I had a capsulor contractor. After the second surgery in April 09 We replaced both implants with cohesive gel silicon 500cc with capsulectomy done on the right breast. Then in December 09' had to revise the left breast that had bottomed out. Now 4 months later im not sure if it is bottoming out again or another capsuler contractor or both!

Doctor Answers (12)

Contracture after revision

+3

Thanks for posting photos so we can TRY to give you a diagnosis and treatment options. First you must realize an in person examination is much better than an internet examine with photos.

Now I feel the right breast is capsuled and an inferior capsulotomy is a choice. If the right implant is a 500 cc than that is all I would do for this side. Of course I would drain this side.

For the left side, it appears as a bottoming out, kinda of. A side view would help, but with the frontal the view is not to unacceptable. If you like the left than either leave it alone or I could recommend repair the bottoming out via internal sutures or a combination of the mesh (Strattice).

Finally, I would inform you of the risks involved and may need more than one operation. Hope I have given you at least a game plan.

From MIAMI Dr. B

Miami Plastic Surgeon
4.5 out of 5 stars 55 reviews

Revision breast surgery

+3

You are heading down the slippery slope of the multiply operated breast implant patient. There is a point where you will never have a good result because of scar tissue and tissue memory. You probably have one last chance for a decent, but not perfect, outcome. Make sure you are in the hands of the very best breast plastic surgeon in your area and listen to their advice even if it means going smaller. The photos might well indicate a recurrent cc on the right because of the elevation and flattening of the lower pole. Good luck with this! You're in a tough spot.

Web reference: http://www.randcosmeticsugery.com

Seattle Plastic Surgeon
5.0 out of 5 stars 44 reviews

Bottoming out or Capsular Contracture After Revision?

+2

I am sorry you're having so much difficulty with your breast implants. This is not typical for breast augmentation. I believe the correct sequence of procedures was done, in that, during your second procedure the implants were changed to silicone and placed in a submuscular position.


Capsular contracture is not uncommon after saline breast augmentation with implants placed subglandular (above the muscle).  Compared with saline implants placed above the muscle, breast  implant capsular contracture is less when silicone implants are placed in a submuscular or under the muscle position.
Based on your pictures I would say you definitely have bottoming out of your left breast implant. To fix this you have several options;  you could either raise  the left breast implant (inframammary) fold or lower the right breast implant (inframammary) fold. Another alternative is to do a little of both.


Concerning your question regarding capsular contracture, it is difficult to say if you definitely have breast implant capsular contracture. If you have pain in the breast and firmness of the breast, you probably have a Baker Grade 2 or 3 capsular contracture.


If you were to undergo surgery I would suggest the following. If the both breast hurt,  I would therefore suggest bilateral capsulectomies for bilateral breast capsular contracture. In addition, I would go with a slightly larger implant on both sides and lower the right implant fold and slightly raise the left implant fold. I would continue with silicone implants in a submuscular position. Good luck with your surgery.

Web reference: http://breastcapsulectomy.com/

Los Angeles Plastic Surgeon
5.0 out of 5 stars 23 reviews

Revision breast augmentation.

+2

Hi.

1) Just going by your picture, you don't have "bottoming out".

2) You may well have contracture of the right breast. The right fold is much higher than the left.

3) I recommend smaller breast implants.

Manhattan Plastic Surgeon
5.0 out of 5 stars 9 reviews

Capsular contracture or bottoming out of breast implant

+1

?Thank you for your question. Obviously it is important that you see your plastic surgeon so that you may be examined and a proper diagnosis made.

My guess looking at your photograph would be that the right breast is forming a capsule which is constricting the breast and making at higher than your left breast. You should be able to determine if this is a capsule by simply feeling the breast and feels harder on the right than the left and you likely are getting a capsule. Again be sure and see your plastic surgeon for an accurate diagnosis

Web reference: http://drseckel.com/surgical-procedures/result-oriented-breast-augmentation-breast-enlargement/

Boston Plastic Surgeon
5.0 out of 5 stars 24 reviews

Capsular contracture

+1

Looking at photos without exam it is impossible to tell, but it appears you have a capsular contracture on the right. If so, the right implant should be tight and hard. If not then it might need revision to drop it down a little.

Columbia Plastic Surgeon
5.0 out of 5 stars 25 reviews

Revison and Revision

+1

.Without examining your breasts, we are all only guessing. Are your implants the same 500cc size. The right appears smaller and may have capsular contracture. The left appears larger and lower. The surgery I recommend if the above is true takes experience and a good plastic surgeon. I would decreased the size of your implants, do a capsulectomy on the right. On the left would require implant exchange and a GOOD internal capsulorraphy with a support bra for six weeks. Placement of a collagen sling would be considered but is expensive

Indianapolis Plastic Surgeon
5.0 out of 5 stars 7 reviews

Implant issues

+1

From the photo, and I would have preferred to see your hands down at your side and not lifted, the right one seems tight.

Manhattan Plastic Surgeon
4.5 out of 5 stars 14 reviews

Bottoming out or Capsular Contracture After Revision

+1

It is difficult to diagnose if the right is contracted but it does appear that your left is too low. I would recommend downsizing with caspsulotomy on right and capsulorrhaphy on left. .

Web reference: http://www.bodysculptor.com/breast-surgery-chicago/breast-enlargement/

Chicago Plastic Surgeon
5.0 out of 5 stars 39 reviews

Do I have bottoming out or capsular contracture?

+1

This is a difficult problem. As most of the responses have stated, you should definitely decrease the size of the implants at the next (hopefully last) operation. The left inframammary fold should be raised and any capsular contracture that you can feel should be fixed (especially on the right). Good luck.

Portland Plastic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.

You might also like...