I Am Becoming Very Concerned About Capsular Contracture. What Do You Think? (photo)

I am 46, 5'4", 118-123. Both 400cc-silicone gel-high profile-unders. Good size for me. From the get go I was high and tight as I had dense peck muscle tissue. I am now 10 months post op and my implants are still high and tight--especially the right. Am I developing capsular contracture? They have not and do not move about freely. I can barely squeeze them together and are hardish when laying on chest. Tips on softening them? Will strapping or laying on them help? Do you think I need surgery?

Doctor Answers (19)

This appears to be capsular contracture.


Comparing your 3-month post-op and your 10-month post-op photos shows progression of capsular contracture. This is particularly evident in the last view with hand pressure causing the severe and "sharp" edge visibility. Especially with below the muscle implants, your breasts should be much softer and gradual in appearance, more like your first 2 photos at 3 months. Are you sure your surgeon went below the muscle? Submammary implants are somewhat more likely to develop capsular contracture because of bacterial contamination of the pocket and biofilm formation which stimulates capsular thickening and contracture. However, this can occur even with below the muscle implants.

Other than a 3 month trial of Accolate or Singulair plus oral Vitamin E (which MAY work to soften capsules in up to half of patients), there is no solution for this problem other than surgery. Pressure by laying on them or using an elastic strap is of no value at this point in time. External ultrasound, infrared, and massage therapy are also of questionable and limited value, so you should see your plastic surgeon (or several ABPS-certified plastic surgeons) for physical examination of your breasts and recommendation for the appropriate surgical intervention. Best wishes!

Web reference: http://www.mpsmn.com/breast-procedures/breast-augmentation

Minneapolis Plastic Surgeon
5.0 out of 5 stars 90 reviews

Capsular Contracture after Breast Augmentation


I would recommend visiting your plastic surgeon to examine you.  Capsular Contracture is a clinical diagnosis and best made by the feel of the implant in the breast pocket.  Thank you for your question.  Capsular Contracture is one of the main risks of breast augmentation.   Classic signs are:

1.  hardness/tightness of the implant
2.  change in implant position (typically migrates towards the collarbone)
3.  increased pain and stiffness on the associated side.
Based on your description, you should see a board certified plastic surgeon for evaluation of capsular contracture.    If present, I would recommend a capsulectomy (removal of scar tissue) and implant exchange. 
Factors to consider:
1.  If your implants are above your muscle, you may want to consider switching to underneath the muscle, which lessens the risk of capsular contracture.
2.  If your implants are above the muscle and you desire to keep them there, you may benefit from the use of a textured implant.
Dr. Gill

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

Houston Plastic Surgeon
5.0 out of 5 stars 32 reviews

Capsular contracture vs tight implant pocket


You clearly have excess firmness of the capsule around the implant which could be related to:

1) True capsular contracture 


2) A fairly tight capsule from a small pocket formation at the time of surgery. 

Either way, in my opinion surgery is indicated.  Either capsulectomy with new implants for capsular contracture or capsulotomy with rrelease of the capsule inferiorly and laterally and replacement of the same implants f a non-pathologic capsule is found.

York Yates MD - Utah

Web reference: http://www.yorkyates.com/plastic-surgery-utah/scars/

Salt Lake City Plastic Surgeon
5.0 out of 5 stars 37 reviews

Capsular Contracture


Unfortunately you have a capsular contracture which is significant scar around the breast implant.  The only good option is to re-operate.  If on top of the muscle i would place them underneath.  Maybe consider a little smaller implants. 

Medication is a option but best for type 1 and 2 contractures.  There are 50 to 60,000 new contractures each year. Common.

good luck.

Web reference: http://www.sanfranciscocosmetic-surgery.com/

San Francisco Plastic Surgeon
4.5 out of 5 stars 24 reviews

Capsular contracture vs small pocket


You really need to see a  board certified plastic surgeon who can examine you and can tell what is going on with your breasts. Pictures just don't tell the whole story. In my experience implants placed under the muscle tend to ride higher than ones on top of the muscle and high profile ones tend to have a sharpe, less gradual transition between the chest wall and the breast. This is more noticeable with larger implants. So I would be more inclined to think your problem is not a capsular contracture but a combination of implant pocket size and location and implant size and shape. If you are happy with the way you look, there would be no need to change it but if you don't like your look, then surgery would probably be necessary. Good luck to you.

Sacramento Plastic Surgeon
4.0 out of 5 stars 4 reviews

Implant capsules


Based upon your photos, it looks like you have a capsular contracture that probably needs removal of the capsule and replacement of the implants.

Manhattan Plastic Surgeon
4.5 out of 5 stars 14 reviews

Concerned about capsular contracture


It appears that from your progression photos that you are demonstrating some form of capsular tightening. It is possible that some of this was the initial procedure as you describe this, but you do show some degree of progressive tightening. Clearly there is limited movement of the implants as well. 

The treatment for either is the same with a release of the capsule to allow for the implant to sit more naturally on your chest. Some patients do show improvement with the off label of Singulair - an asthma drug - but you  would need to talk to your surgeon about this.  Otherwise, it is likely you will need a surgical revision to improve the appearance and feel of your breasts.

Best of luck,

Vincent Marin, MD
San Diego Plastic Surgeon

San Diego Plastic Surgeon
5.0 out of 5 stars 21 reviews

Misshapen breast after breast implant and capsular contracture


Your posted photos show implants that appear to be above the muscle (despite your describing them as unders), are centered above the nipples and have a sharply visible edge with flattening of the inner lower quadrant contour on the left. You stated this high tight appearance has been present since surgery rather than developing over time so it is more likely to be inappropriate implant/inadequate pocket than it is capsular contracture. The treatment is the same though: adjustment of the pockets and possible replacement of the implants as well as placing the implants under the muscle since you have so little upper breast pole soft tissue to cover the upper edge of the implants.

I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Los Angeles Plastic Surgeon

I Am Becoming Very Concerned About Capsular Contracture. What Do You Think?


Thanks for the posted photos. You have a severe capsular fibrosis that needs attention via surgical release. I believe you are submuscular but very hard to tell. Follow up please

Miami Plastic Surgeon
4.5 out of 5 stars 55 reviews

Breast implants are high and tight


If the implants have always been high and tight it is more likely that you have problems with the implant pocket and perhaps the implant selection. The HP implant is rounder like a grade I capsule, but your point of projection from the implant is above the nipple. If you like your result you do not need surgery.

Best of luck, peterejohnsonmd.com

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

Chicago Plastic Surgeon
4.0 out of 5 stars 25 reviews

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.

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