Swollen, Hard, Right Breast and Redness/swelling at Incision Site Five Weeks Post Op - Seroma or Capsular Contracture?

At four weeks post silicone sub-muscle augmentation my right breast became increasingly swollen and hard. At five weeks, it is warm to the touch and the incision site has progressively reddened, although no fluid has leaked. I am also very swollen sore on the right side of my abdomen; my left breast if perfectly fine. Getting ultrasound to detect fluid; If not, my ps believes it is capsular contracture and i must wait until I am 3 months post op for revision surgery?!

Doctor Answers (11)

Unilateral breast pain, hardness, redness, swelling, and warmth 5 weeks post-op. This needs surgery!

+1

You clearly describe substantial differences in your breasts, and 5 weeks is indeed early, but not unheard-of, for development of capsular contracture. What has every consultant here listed as possible concerns?

  1. Hematoma/seroma (Blood/fluid)
  2. Infection
  3. (Early) Capsular Contracture

Until recently, when leukotriene inhibitor (Accolate or Singulair) therapy was described in the plastic surgery literature as a possible non-surgical treatment for capsular contracture, ALL 3 OF THESE POSSIBILITIES require surgical intervention for proper diagnosis AND treatment.

Hematoma does not "go away" on its own; this requires surgical drainage. If ignored, this is one of the surest ways to stimulate capsular contracture. Only prompt surgery and thorough evacuation of the blood and control of the bleeding source will reduce the now-increased risk of capsular contracture.

Infection around an implant cannot be successfully be overcome with antibiotic therapy. The implant(s) must be removed as they have no innate biologic mechanism to fight off infection--no blood vessels, antibodies, or route for antibiotic therapy to reach the warm, wet space between the implant (foreign body) and your living tissues. (BTW, if antibiotic therapy "works," the patient probably did not have an infection if the first place; it probably was a seroma or a small non-expanding hematoma that was incorrectly diagnosed as a possible infection.) Real infection requires surgery.

And if leukotriene-inhibitor therapy is unsuccessful, surgery is necessary to perform capsulotomy or capsulectomies.

So, you can see that surgery is the required step for all three of the possible scenarios given. You do NOT need ultrasound studies to help you or your surgeon make a decision; this is an unnecessary, costly, and simply a delaying step. But perhaps delaying for a few more days will send your (probable) infection symptoms through the roof--THEN you will be certain of the need for surgery!

You do need to see your surgeon; examination will confirm what you have accurately described, or determine that you have described something else in dramatic fashion. I have no reason to presume the latter, and thus I would simply proceed to the operating room where the problem can be diagnosed definitively, and treated appropriately. It's easy enough to discuss the proper surgical steps for each of the probable diagnoses! Get going and see your surgeon now! Best wishes! Dr. Tholen


Minneapolis Plastic Surgeon
5.0 out of 5 stars 109 reviews

Possible breast implant infection - Urgent problem

+1

I would be most concerned about an infection with the problems you are describing.  You should get in to see your plastic surgeon as soon as possible before the problem gets worse.  The longer an infected implant remains in place the more complicated the recovery and re-augmentation due to scarring.  

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 8 reviews

Redness and swelling and hardness of breast at one month

+1

I think an exam in person is critical. Some of the description you report sounds like an infection.  Can't say for sure without an exam, best to see your surgeon.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 15 reviews

You might also like...

Hardness, redness, and swelling 1 month post-op after breast augmentation

+1

The problem with the signs and symptoms that you are describing is that they are all very non-specific.  That is, they can all be shared by a number of different possible diagnoses, many with totally different treatments.  You are seeing this now in this forum as there are many different surgeons each offering a different suggestion of what is going on.  Clearly there is something going on with that right breast, and it needs to be diagnosed and treated.  The breast implant is the one common denominator, but whether the hardness, swelling, pain, and redness are coming from an untreated hematoma, an infection, an early aggressive capsule inflammation which would ultimately develop into capsule contracture, or something different from all of those remains to be discovered.  It is also pertinent to know whether fever or sweats are part of your symptom complex too.  The ultrasound is a good idea, and maybe even a blood count should be done too.  In the end, it may wind up that surgical exploration will be necessary to either diagnose the problem, treat it, or both. In any event, this situation bears close watching and an aggressive treatment approach by your surgeon.  Good luck!

Joseph L. Grzeskiewicz, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 10 reviews

Redness after augmentation

+1

Because of the swelling and redness, I would tend to agree with the others on this and I would be more worried about a late hematoma or fluid collection and perhaps infection.  I am glad to hear that you are following up regularly and getting the ultrasound.  That side might need to be explored and drained.  Antibiotics may also be necessary.  Good luck to you! 

Jennifer Lauren Crawford, MD
Austin Plastic Surgeon
5.0 out of 5 stars 6 reviews

Breast pain

+1

Thanks for your inquiry, sorry you are having a hard time.  Without a picture, it is hard to comment.  You definitely should be seeing your surgeon regularly.  Your breast should not be warm or red from early encapsulation.  Good luck.

Vishnu Rumalla, MD
Dallas Plastic Surgeon
5.0 out of 5 stars 68 reviews

Possible infection after breast augmentation

+1

From your description, I am more concerned about infection, but cannot say for sure without the benefit of an examination. Please call your surgeon today!

Mark D. Epstein, MD
Stony Brook Plastic Surgeon
5.0 out of 5 stars 139 reviews

A hard and swollen breast five weeks after augmentation is not capsular contracture.

+1

I don't think it's even biologically possible for capsular contracture to occur at five weeks. It sounds as though you have an untreated hematoma which is easily diagnosed and should be treated by drainage.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 7 reviews

Swollen, Hard, Right Breast and Redness/swelling at Incision Site

+1

Your two suggestions are possibilities, but my concern would be for infection. Close regular follow up with your surgeon is vital until infection has been excluded as a possible cause. 

All the best. 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon
4.5 out of 5 stars 30 reviews

Swollen, Hard, Right Breast and Redness/swelling at Incision Site Five Weeks Post Op - Seroma or Capsular Contracture?

+1

Dear Kahana,

Thank you for your question/photo.  It is difficult to tell exactly what is going on from just your description.  If just the incision itself looks more pink/red/purple, this can be normal course of scar healing.  If the area of redness is expanding from the incision to the normal skin and continues to expand, this could be a sign of infection.  Keep a close eye on this and report back to your plastic surgeon.

Best Wishes,

Pablo Prichard, MD

Pablo Prichard, MD
Phoenix Plastic Surgeon
5.0 out of 5 stars 24 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.