Capsular contraction, big gap between the breasts, and maybe bottoming out? (Photo)

Diagnosis of a capsular contracture would require an in-person exam, but the photos do appear to show some bottoming out on the right side. They also appear to be relatively large implants which are difficult to support in a thin person, so be cautious about going larger. One option might be an internal bra using SERI Scaffold silk, Strattice, or similar material to hold the implants up an closer together. If you do have a CC, then this will be very important because the treatment will involve removal of the scar capsule, leaving even thinner tissue to support the implants.

Surgery is the only effective remedy. Revision surgery is almost always more complex than breast augmentation. Correction techniques vary based on your plastic surgeon’s experience and skill sets. Always choose a board certified plastic surgeon with expensive revision experience as even in the best of hands recurrence is frequent especially if larger implants are used. Repair techniques include some of the following techniques and recommendations:Textured implants (“Velcro effect”)Use of Smaller ImplantsMaximum Submuscular Position (not just the pectoralis major but abdominis rectus below and serratus anterior on the side)Capsulorrhaphy (tightening the pocket by sewing in-folded capsular tissue together)Use of Biologic fabrics and other materials such as Acellular Dermal Matrix, “ADM” Alloderm, Strattice, “Silk” and others that can be used to reinforce the bottom of the pocket.Change of position of implant to a new pocket location “neo pectoral pocket”Internal Ryan Procedure (sutures binding the inferior mammary fold to stronger underlying tissues (e.g. fascial, periosteal)Removal of Implants and replacement of volume using your own fat (Fat Transfer).The procedure is performed under general anesthesia on an outpatient basis most often using an existing scar or making an incision beneath the breast. Recovery is similar to your original breast augmentation procedure. Use of taping after surgery and prolonged use of a support bra is often recommended. It is far more important to pick the best plastic surgeon rather than trying to pick the best procedure as they are in the best position to guide you to the right decision.

Thank you for the question and photos. I believe that a complete revision is necessary. Your size looks good so you have a few options. You could continue with round high profile implants or switch to a highly projected tall height shaped silicone gel implant which will maintain a full and nicely shaped upper pole and similar breast projection. I would recommend also the use of a dermal graft in the lower pole for support and capsular contracture prevention. You are young and thin and revisions are expensive so I recommend going for the most reliable single procedure. Discuss this with your board certified Plastic surgeon. In the implant revision section of my before and after photos there is a similar case, at drmouchantat.com.

Yes, it looks like you have some "bottoming out" on the right side.Typically, we see these 3 features when this happens:1) loss of upper pole fullness2) upward orientation of the nipple3) increased distance from nipple down to infra-mammary fold.This could probably be fixed with internal suturing of the pocket, reinforced with Strattice or similar material.  I would advise against going larger - the extra weight of the implant works against the chances of the repair healing properly.

Dear BeautifulBreastsThank you for your question!  The capsule contracture and the bottoming out can be challenging - especially with large implants in a small frame like yours.  A detailed consultation is very important- as the long term consequences- such as the need for MORE surgery are serious.You should discuss this with your surgeon- the favorable procedures such as Strattice and SERI have their own risks and do not necessarily prevent long term issues.With Warm RegardsTrevor M Born MD