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What to Do if Breast Still Feel Hard and Won't Drop?

Hi, I've had my implants for a year now and they still feel and look fake. they are not as hard from when i first got them but still feel hard and one breast is higher then the other.I think it still haven't dropped. I got them under the muscle. I went from a 32A to a 34B with a 320cc if that helps. What can i do? or WHat do you recommend?

Doctor Answers (11)

Implant hardening

+2

The most common problem seen with breast implants is capsular contracture.  It appears you have developed some capsule formation around your implants.

Our bodies defense mechanism is very strong and it recognizes the breast implants as a foreign object and will try to protect your body from this "invader" .  It is no different than a reaction to a splinter in your hand or hip prosthesis or pacemaker.  A wall of scar tissue surrounds the implant and can squeeze or compress the implant.  Everyone, 100% of the patients, will develop a capsule around the implants.  If the capsule becomes symptomatic, is what varies from individual to individual and even from breast to breast in the same patient.  The capsule can make the implant look and feel hard, displace it superiorly, laterally and prevent it from "dropping".

We really don't know why capsules develop, so there is not a cure, but we do know some facts that can reduce the incidence of capsule formation.  Implants placed under the pectoralis muscle have a lower incidence of capsule formation.  Saline implants have a lower incidence of capsules compared to silicone implants.  Post operative fluid collection (seroma or hematoma) will lead to a higher incidence of capsules.  Radiation to the chest/breast will increase capsules (seen in breast reconstruction for breast cancer).

What steps can a patient take to help prevent capsules?  There is no statistical proof that implant massage helps, but I think it does, and start all my patients on implant massage 1 week after surgery.  If firmness starts, then you start taking Vitamin E, 2,000 IU, daily.  This is a massive amount of Vitamin E, but it is not harmful, there are no side effects, it is OTC, and well tolerated.  Vitamin E should be taken for 3 months, 50% of the patients will respond with softening of the capsules. 

If the Vitamin E does not work, than take Singulai,r 10 mg, daily for 3 months. 50% of the patients will respond to Singulair.  Singulair is an anti-asthma medication that is a prescription and is more expensive than Vitamin E.  Insurance may or may not cover the prescription cost.  Singulair and Vitamin E can be taken together.

If Singulair does not work then the next medication to try is Trental.  Trental is a medication used to treat peripheral vascular disease and seems to work by relaxing the smooth muscle in arteries.  Microscopic examination of the capsules around breast implants reveals the same smooth muscle cells that are in arteries.  It appears Trental works by relaxing the smooth muscle cells.  The dose of Trental is 400 mg, three times a day with meals, and should be taken for 3-6 months.

If all 3 medications fail and your implants are still firm, than you will need a surgical release of the capsule, a capsulotomy or removal of the capsule, a capsulectomy.  This is a surgical procedure and the success rate is only 50%, so it is the last resort.  It appears whatever mechanism that causes the capsule in the first place is not cured by the surgery, that is why the failure rate (50%) is so high.

So, in summary; I would start implant massage immediately and start on Vitamin E, 2,000 IU daily for 3 months and than re-evaluate.  If no improvement I would move onto Singulair.

I hope this helps!


Omaha Plastic Surgeon
5.0 out of 5 stars 46 reviews

Capsular contracture?

+1
If the implants still feel and look fake you may have a capsular contracture on that side.  The thick scar tissue that forms can deform the breasts and make them feel unnatural.  If capsular contracture exists, you will need a capsulectomy.  Capsular contracture can recur after surgery so make sure you find a good plastic surgeon.

Eugene Kim, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 4 reviews

Implant firmness

+1

Hello,

Implant firmness can be caused by a handful of different reasons.  Early on swelling is the reason, after the swelling goes away if some residual unwanted firmness exists it is usually caused by a pocket that is too small.  This is particularly common when performed under the muscle.  An increase in firmness is caused by capsule contracture.  Capsule contracture will need to be treated by revision surgery to remove the capsule.

All the best,

Dr Repta

Remus Repta, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 96 reviews

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Implants that are still high and firm-likely capsular contracture

+1

Based on your description, it sounds like you have capsular contracture- which is hard scar tissue that can develop around your breast implants. This happens in about 10% of all patients who have breast implants. The scar tissue prevents the implants from settling and therefore they remain "high" on the chest wall and hard to the touch. I recommend consulting with a board certified plastic surgeon for a complete exam and review of your treatment options-which will likely involve surgery.

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William Bruno, MD
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Hard Implants after Breast Augmentation

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Many patients experience some degree of firmness after breast augmentation and for most it is a minor issue or not even noticed by them. Overly firm feeling implants can be a real problem for some patients and there are a limited number of options for these patients. The time tested method is to exchange implants and remove the scar tissue, combined with readjustment of the implant pocket to help the implants sit in a better position. See a surgeon who can evaluate your condition and make the most appropriate recommendations. Best of Luck  Dr Harrell

Jon F. Harrell, DO
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Implant hard and not dropping

+1

It sounds like you may have a capsular contracture on the side you describe as hard and not dropping. Early postoperatively or with early capsular contracture, I recommend massaging, but if this has been the same for a year, massaging is unlikely to help. Placing implants under the muscle helps reduce the risk of capsular contracture, but it does still happen. I recommend following up with your plastic surgeon, or another board certified plastic surgeon if you need another opinion. Typically longstanding capsular contracture is treated surgically, with releasing or removing part or all of the capsule, and possibly changing the implant pocket.

Anita Patel, MD
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Implant problems

+1

If you breasts feel firm and high at one year, then you  may have a capsular contracutre. But without an exam I ould not be sure.  See a surgeon to be evaluated.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 17 reviews

Breast implants firm and high after augmentation

+1

After a year it can be hard to say if you have a problem with a breast capsule, or the implant pocket was not released enough for the implant to sit and center within the breast. A second opinion would be best if you are unhappy and think things should look better.

Best of luck, peterejohnsonmd.com

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 30 reviews

Breasts hard and haven't dropped and look fake

+1

If after a year your breasts are still unnaturally firm and look fake you likely have a capsular contracture. This will not resolve on its own and will require revisional surgery. Unfortunately there is a chance the contracture will recur. Get opinions from experienced breast surgeons before proceeding! Good luck!

Marcel Daniels, MD
Long Beach Plastic Surgeon
5.0 out of 5 stars 19 reviews

What to Do if Breast Still Feel Hard and Won't Drop?

+1

Best to obtain a few in person second opinions from boarded PSs in LA. If you think you look fake than you either are too large or have CC. regards 

Darryl J. Blinski, MD
Miami Plastic Surgeon
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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.