Kent (Kye) Higdon, MD

Thank you so much for your question.  Capsular contracture is a complication that can occur after implant breast surgery.  This ranges from a soft capsule that is nondeforming, which is Baker grade 1 contracture, all the way to Baker grade 4 contracture, which is a firm, painful, and deforming capsular contracture.  Capsular contracture can happen in the early postoperative period but also can occur many years after surgery for a variety of reasons. In cases where the implants are made of silicone, it can represent a rupture of the silicone implant.  In other cases, it can result from bleeding, infectious, or other complications.  Years ago, physicians would treat capsular contracture with closed capsulotomies, which is a dangerous procedure that can result in significant pain, deformity, bleeding, and frequently recurrence of the capsular contracture.  Now, in some cases, where there is a grade 2 capsular contracture (breast is slightly firm but the shape is not deformed and not painful), medications called leukotriene inhibitors can be used in an off label manner to address capsular contracture.  The typical manner of treating capsular contracture is surgical removal of the capsule, implant exchange, and possible conversion from above the muscle to under the muscle, or vice versa, depending on the circumstances.  I myself use a no touch technique with antibacterial irrigation where the implant goes from the manufacturer's sterile packaging into a Keller funnel and then into the breast pocket without being touched in order to decrease the risk for my patients of getting capsular contracture.  I wish you the best in your treatment journey for capsular contracture and suggest seeking the care of a board certified plastic surgeon for your care.




Good luck!




Dr Higdon

Amanda,

This is a great question, the answer to which really depends on a few factors specific to your breast augmentation. Generally, recovery after primary breast augmentation involves a 3-7 day period of some soreness particularly if the implant is placed under the muscle, or the subpectoral position.   In cases where the implant is placed on top of the muscle, or the sub glandular position, the recovery is typically even shorter.


I recommend walking the day after surgery but would avoid strenuous exercise for a month or so after surgery to avoid complications that can result.

You will usually see a healing thin scar over the first few weeks that will become more pink for a few months as you heal, and then fade over the course of months.  I recommend silicone gel sheets at 3 weeks for the incision.  Natural scar healing time takes a total of 18 months in the healthy patient.  

Bra use can be variable depending on scar location and the type of bra you prefer to use.  I recommend not using underwire bras when an inframammary or lower pole incision is made for obvious pain control issues when the underwrites can compress the healing tissues and scar.  Sports bras with support can be a reasonable option at the right time, but usually I recommend a postoperative bra that I give to my patients that is just right in terms of size, support, and gentle compression to help with swelling.

I usually recommend my patients take a few days off (3-5 days) driving until they are off analgesics. 

Specific questions about your exercise regimen, sleep patterns such as sleeping on your side vs your back, and return to work should be discussed with your plastic surgeon, as these have particular nuances that need to be tailored to your own lifestyle and possibly can affect your results if resumed too soon.  




I hope this answers your question and would be glad to help in any way going forward!




Sincerely,




Kye Higdon, MD, FACS

Board Certified and Cosmetic Fellowship Trained Plastic Surgeon

Great question! Augmentation mastopexy of the breast is a procedure commonly performed to improve the volume and shape of the breast.  The changes that this procedure addresses, such as breast ptosis (sagging of the breast), deflational atrophy, and asymmetry, can occur after breast-feeding, weight loss, congenitally, or with aging. The augmentation part of the procedure uses an implant, typically, to fill out the volume of the breast.  The mastopexy is the "lift" portion of the procedure  where the breast tissue and nipple are repositioned to make a beautiful breast with proper proportions with the augmentation.  As I mentioned above,ometimes there are asymmetries, or differences between one side and the other that can be corrected in terms of breast size as well as nipple size and nipple position. All of these can be corrected by a board-certified plastic surgeon.

One of the most difficult parts of the recovery after primary breast augmentation, or any revision breast augmentation surgery, is sleeping. I, like many surgeons recommend you sleep on your back for the first 6 to 8 weeks after surgery to allow for proper capsule formation  and decrease risk for malposition of the implants. At that time, I recommend stomach sleeper patients consider trying to sleep on their sides to keep their arms and body weight off of the employees. Stomach sleeping is discouraged for a variety of reasons. Any sleeping on the stomach or the sides can result in shape changes that are usually undesirable. Often soft pillows and bed wedges can help in this process!  

 Focal suction techniques and pressure techniques cause mild, focal edema (swelling) of the breasts, which is usually temporary and does not offer a substantial increase in volume during that temporary time frame. The BRAVA  Device is a total breast suction technique with a large device that is applied to your breast and suction is performed for long durations to allow for the press to swell. This is usually followed with a surgery called autologous fat grafting to fill the swollen breast with fat from another part of your body. Without this fat grafting, and the breasts would lose their swollen volume.  The most common method progress augmentation is breast augmentation with an implant. In either case, I would recommend you consult with a board-certified plastic surgeon with expertise in breast augmentation to discuss with you the differences in the techniques, the pros and cons, and safety of each in your particular case.