Chris Cartlidge, FRCSEd

Definitely you are doing the correct thing to be seen by your doctor. The most likely issue is a muscle strain (depending on whether your implants were placed under the muscle, they may be more prone to strain). It is always worth checking to make sure that there hasn't been a complication with the implants (unlikely) or bleeding next to the implants (haematoma, might need washed out).

Thanks for the photos. I can see you had a difficult time after your first procedure, it must have been really demanding to have to go through surgery again. It isn't easy to know how things are going to end up with this. If you have had capsular contracture after your first procedure then you will be at higher risk for similar after a second procedure. A coupde of questions come to mind immediately: 

• Was a complete capsulectomy performed during the second procedure?
• Did you consider anatomical (teardrop) implants for the second procedure?

The area of rippling appears to be in the lower inner part of the left breast. This can normally be helped with some fat-transfer (lipofilling) but I can see that you do not carry much in the way of excess fat- which is very good for your health overall..! There is some evidence that massage may help reduce capsular contracture rates, so it certainly wouldn't do any harm to try. In the meantime, be sure to wear a supportive, sports-type bra without underwire.

Thanks for posting the photo. i can see you have had a left mastectomy and implant reconstruction and it looks like there was a symmetrising procedure on the right (wise-pattern reduction mammoplasty). It is a difficult problem to deal with and requires a very high level of expertise. I am not in any way criticising your original surgeon as it is often not clear what the outcome will be until much later on.

If you were my patient, and very much depending on your hopes and desires, I would be looking at leaving the right side alone and revising the left side. I think the lower breast crease (infra-mammary fold) needs to be reconstructed so that it is higher and matches the right side. At the same time I would replace the implant for one that is more closely matched with the right side volume. Finally, at the same surgery, I would undertake a lipofilling procedure to give more upper-pole fullness, a more natural shape and look. I would expect a good result from this but would also caution that further lipofilling procedures may be required in the future to get as near-to perfect a result as possible. I hope this helps. Best wishes, Chris.

The most likely answer is that there has been a build up of fluid below the nipple following your surgery. When the nipple is spared, the ducts below the nipple are divided and open freely into whatever is underneath (e.g. an implant). Many surgeons put wound glue over the top of the nipple at the end of the operation to prevent any infection from travelling from the skin into the implant. For any number of reasons there can be a build up of fluid below the nipple, and when this reaches a certain volume it will discharge out of the nipple. Putting you on antibiotics is very sensible. The previous radiotherapy may have made it more likely for fluid to build-up.