Roderick M. Urbaniak, MD

Hi and thank you for your question!  Firm breast after breast augmentation is capsular contracture until proven otherwise.  Your history of a post-op hematoma (if in that breast) certainly would predispose you to developing a capsular contracture in that breast.  Unfortunately, without a clinical exam, it is only speculation.  Best to seek a consultation with a board certified plastic surgeon.  Best of luck!

RMU

Hi and thank you for your question.  It is not entirely accurate to say textured implants CAUSE cancer (ALCL).  There MAY be an association.  This is a complex issue that we do not yet fully understand.

In terms of smooth round implants that have the firmest gel, at least in the United States, this would have to be the Allergan's Natrelle INSPIRA cohesive line.  You should seek a consultation with a board certified plastic surgeon to determine if THAT particular implant is right for you.  

In terms of capsular contracture rates for that implant specifically, there is no data yet as it is brand new.  Smooth round silicone gel implant contracture rates can vary between 3 and 20 percent based on incision choice, plane of placement, other particulars of sugical technique, and others.  Best of luck!

RMU

Hi, thank you for your question.  To truly understand what is really going on in your right breast it would be helpful to see your pre-op photos and have additional surgical and implant details.  It looks like your arms are up in both photographs you submitted?  (which technically is not animation deformity)  What happens (and what do your breasts look like) with your arms down?  With your pec muscle contracting?  Are your breasts soft?

My best guess is that you had a fair amount of asymmetry with a tight right inframammary crease and lower pole which can appear this way with arms up post operatively.  Repairs are possible.  They are surgical and would likely involve additional releases of right pectoralis muscle (dual plane) - assuming you are submuscular -- and likely switching out your implant(s).  Fat grafting can also help but there are unique issues related to fat grafting to breasts that warrant further discussions with a board-certified plastic surgeon.  If you are no longer comfortable with your surgeon, you should seek a second opinion with another respected BC plastic surgeon in your area.  Best of luck!

RMU

Hi and thank you for your question!  Generally most plastic surgeons feel that silicone breast implants have a more natural feel, and better cosmetic outcomes than saline implants.  Detailed discussion of pros and cons and how it all relates to your specific case is outside of scope of this discussion.  It is best to see a board-certified plastic surgeon in your area for a formal consultation.  

In terms of your result and your right nipple -- it appears that you had significant/severe asymmetry preoperatively, and perhaps also experienced some delayed healing at the 3 o'clock area of your right areola.  Stitch abscess, cellulitis, excess tension or similar can cause a wide, irregular scar that I see at that location.  Currently you have a poorly healed right circumareolar scar, asymmetry in the degree of drooping (ptosis) of your breasts, and severe areolar size asymmetry, which is probably the most striking.  From the looks of it, you may benefit from a revision mastopexy (likely vertical) on the right with significant reduction of the size of the right areola.  Whether or not you want to change your implants depends more on if you are happy with volume (size) of your breasts.  So in short: (1) yes this result likely can like be improved with revision surgery (2) you will likely still have some asymmetry after revision surgery.  Hope this helps and good luck!

RMU

Hi, thank you for your question and photograph!  Benelli mastopexy has once been quite popular but now seems to be somewhat falling out of favor, at least in my hands.  It is not a very "powerful" lifting technique, and can flatten, distort, or cause "herniation" of areolae.  In my opinion, an interlocking gortex (spokewheel) peri-areolar mastopexy is a better technique in appropriate candidates.  

The real question is whether or not you are an appropriate candidate for such procedure.  It is a little difficult to tell you just from looking at the photo.  Your lower poles are somewhat tight/high with short nipple-to-inframammary fold distance.  What I cannot ascertain is the amount of stretch or laxity contained in the lower pole skin.  If your lower pole skin has lots of stretch, perhaps a breast augmentation could suffice, maybe even with an anatomic implant (which tends to stretch lower pole preferentially).  So therefore, I recommend a consultation with a board certified plastic surgeon who can discuss these options with you.  Best wishes!

RMU

Thank you for your question.  This is a very complex issue, and I highly recommend you seek a consultation with a board-certified plastic surgeon to help you navigate through the complexities of this decision.

Simply put, breast implants provide very modest lifting of nipple/areolar complex.  Implants are not designed to lift, but rather to add volume and "fill" the breast and skin envelope.  If your breasts are very droopy you will likely need a breast lift.  Whether or not an implant should be added has to do with whether or not you want your breasts to also be larger.  In summary, desired breast size and volume, ability to except and tolerate scars around your areola and on the breast, and your expectations regarding above will all affect this decision that you and your plastic surgeon should make together after you are fully informed and comfortable.  Best of luck!

RMU

Thank you for your question.  Many patients find it difficult to disrupt their workout routines.  As many mentioned before, best advice is - listen to your body.  If certain movement or activity causes discomfort, don't push it.  Generally, light cardio exercise (no impact) is appropriate at 2-3 weeks (ex. stationary bike), while heavy and/or strenuous activities such as treadmill or weight training may have to wait for 4-6 weeks post op.  It is also smart to start light and work up gradually.  Best of luck!

RMU

Thank you for your question!  Common sings/symptoms of capsular contracture are increased firmness in (either) breast, increase in upper pole projection (usually submuscular implants), shape change with implants becoming more oval or square or they begin to "stick out" as you put it, asymmetry, discomfort/pain, diminished "mobility" of breast (for example when you raise her arms up or jump up and down), and in extreme cases, nipple or skin retraction.  This change can be quite slow/gradual and is often missed by many women.  

Clinical examination by an experienced clinician is the gold standard in diagnosis of this complex problem.  Thick capsules can also often be seen on imaging such as ultrasound, MRI, and really old capsules can sometimes be seen on mammography as they can be heavily calcified.  The issue you are describing certainly sounds like capsular contracture; please seek a consultation with a board certified plastic surgeon in your area.  Best of luck!

RMU

Thank you for your question!  Recovery from surgery can vary quite a bit based on your anatomy, pain tolerance, surgical technique, incision choice, implant size and implant location (over the muscle vs under the muscle).  Generally speaking, you can return to a "sitdown job" within 5-7 days, while more "strenuous" jobs may require as many as 4-6 weeks for full duty return.  Light aerobic activity is usually allowed at 3-4 weeks but heavy aerobic activity and things like weight training are not recommended until about 6 weeks post op.  Implants typically "settle" and "shape" for 4-6 weeks post op, with most of the swelling resolved at 3 months post-op.  Scars may take as long as 9 -12 months to fade based on your skin type and healing capabilities.  I hope this helps and best of luck!

RMU

Thank you for your question!  Generally breasts begin development around puberty (range 8 - 13 years old) and subsequently are fully developed 3-5 years after that.  Your breasts will continue to change throughout your life however, with most pronounced changes around pregnancy and menopause.  I hope this helps!

RMU