How Soon After Surgery Can You Tell if You Are Encapsulating?

I have had 5 breast surgeries this year,(one implant exchange, two capsulectomies on the same side, hematoma on same side, and exploration and pocket cleaning/draining, same side) I am two weeks post op and my breast feels tight, and when I take a deep breath, it feels like way inside the breast is kind of stretching or pulling. PS says it's normal, but I have developed 2 capsules already and would like to prevent another from forming. Any advice/help?

Doctor Answers 13

Capsular contracture

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As others have indicated the cause of capsular contracture is unknown. Bacterial involvement is currently a popular theory. Treatment can be frustrating with recurrence being common. The capsule does not start to form until about three weeks. Tightening can occur at any point. Although you could be experiencing swelling, it would be a little early for you to have capsular contracture. Depending upon the treatment you had, it may have been inadequate. For recurrent capsular contracture, placement of of allograft (skin substitute) is showing promise and I have personally had good results using this for the treatment of capsular contracture. It has been proven helpful in animal models and some clinical case studies. A large well done study is not yet available. There is nothing you can do to prevent this from happening again. The other options of vitamin E, massage, singulair, etc have not been shown to decrease the rate of capsular contracture. To my knowledge external ultrasound has not been studied. None of these methods have a significant downside and I would not necessarily discourage a patient of mie from trying them, but I do not advocate them. Fat grafting may been a viable option to augment the breast for implant failures although this is not FDA approved and our society's position is that this needs further investigation before becoming a recommended option. Depending on the size implants you have, fat grafting may not be able to duplicate the size increase.

Capsular contracture usually starts early, but can occur late as well.

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One of your breasts has had all 5 operations, and all of the capsular contractures. Based on this, and if your other breast is soft and without capsular contracture, this is NOT a healing characteristic related to YOU, but rather another reason that your one breast has repeatedly re-formed a contracture.

The most common causes of capsular contracture are bleeding and bacteria (not necessarily a true "infection," but rather implant contamination from skin or intraductal bacteria) causing a biofilm on the implant's surface that stimulates your body to produce "extra" inflammation and scarring.

This is why I recommend antibiotics when my breast augmentation patients receive dental care (I'm in a small minority on this one, I know), and why I always use dilute Betadine rinses in the breast pocket, on the patient's skin, and now use a Keller funnel for a true "no-touch" technique--all designed to reduce the potential of bacterial contamination of the implants. It's also why certain asthma medications (leukotriene inhibitors Accolate and Singulair) MAY help reduce a component of inflammatory response that MAY be part of the scar-inducing, capsule-contracting process. Oral Vitamin E is usually prescribed in addition to these, and may have a role in reduction/prevention of capsules as well.

In specific cases, intra-pocket steroids (at the time of surgery) MAY help reduce the tendency for recurrent capsular contracture, but use of these medications is a two-edged sword--these can cause weakness in the incision or scar, and higher chance for extrusion, exposure, or other concerns. Still, this is an option I have used over the years in some cases similar to yours. Too late after the surgery, but something to consider if you end up with another capsule.

You may also need to consider a new implant, as the present one may well be contaminated and have a biofilm. Elimination of biofilm-contaminated implant(s) automatically occurs if implant(s) are removed for weeks to months, after which new pockets and implants are used. The ones in you now SHOULD be sterile, but what if the recurrent capsule side is because of a pesky (invisible) bacterial biofilm?

I have also used external ultrasound for over 20 years for resistant or recurrent capsules, and have found it to be helpful only in about half of cases. However, for that half, it was a godsend!

As you can see, capsular contracture is a problem for which there is no reliable and predictable treatment. Prevention is the best recommendation of all. I am so sorry this is too late for you, but for other women considering breast augmentation, understand that capsular contracture is usually not some random occurrence that pops up and strikes unwitting patients and surgeons. Surgeons who use blunt dissection techniques (gloved finger dissection, tissue expander via scope, or "hockey stick" type instruments) may have more bleeding, bruising, and resultant capsular contracture. Careful surgical technique with ultra-precise bleeding control is ALWAYS better (but may take a few minutes more). Use of a surgical drain is not necessary if there is no blood or fluid to evacuate, which avoids a "superhighway" for bacteria INTO the breast pocket and implant surface! And having antibiotics in your blood stream and capsular tissues when dental work causes a bacteremia just may prevent a "minor-breast bump or injury-plus-exposure to bacteria" induced capsular contracture.

After all, you aren't PLANNING on an accident happening when you get into your car for a drive somewhere. But you still (should) wear your seatbelt . . . just in case!

Hang in there, Yoamba, and good luck!

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
4.9 out of 5 stars 263 reviews

Breast Augmentation

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With two previous capsule contractures you are clearly at higher risk than normal.  But, feeling tight after surgery is fairly normal and I think it is too soon to make that determination.  Allow 6-8 weeks to pass before any decisions are made.  Your Board Certified Plastic Surgeon will be able to determine the capsule formation if one occurs.

Vivek Bansal, MD
Danville Plastic Surgeon
4.9 out of 5 stars 26 reviews

Capsular contracture recurrence?

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Based on the your prior experiences, you may be prone to development of capsular contractors. Of course, it would be natural to be highly sensitive to any tightness in the breast. You should follow up with your plastic surgeon at regular intervals, perhaps every two weeks given the history. I do share the concern of others on this forum that, if you do go on to develop a capsule, you will have to seriously discuss your options, including foregoing implants, with your plastic surgeon.

Five breast surgeries in one year is way too much

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You have had a bad time.  This is too much surgery and too many problems.  Aside from the cause, operating on any tissues so often makes scarring much more intense and never allows the healing from one operation to finish before the trauma of another operation.

Regardless of what is happening, you need 6-12 months without surgery for your breasts to recover.  Then find an experienced surgeon who can advise you.


Good luck.

Mark B. Constantian, MD, FACS
Nashua Plastic Surgeon

Capsular contracture

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It is too early to tell if your capsule is returning.  You definitely are at a higher risk with your previous history for recurrence.  If your capsule does return discuss with your surgeon the use of acellular dermal matrix which has been shown to decrease capsule reformation.  It is expensive though but may save additional costly surgery.  Donald R Nunn MD Atlanta Plastic Surgeon.

Donald Nunn, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 51 reviews

Capsular contracture after Augmentation, how soon?

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I have seen capsular contracture as early as 2 weeks post op, or at least a pocket that is possibly heading in that direction.  I have my patients do implant displacement exercises, and I see them every couple of weeks to make sure they are doing them correctly and to assess whether their pockets are staying open and the implants softening as I would expect, or whether the pockets are closing down. I certainly have sseen patients at two weeks whose pockets are not as "open" as I know I made them at surgery, and I have been able to "push" the implants around better than the patient can and "open " them back up...if done early.  So, I would go see your surgeon about your concerns.  By the way, I echo the concern oer having 5 surgeries in a one year period...this is highly unusual and I wonder if you should get a second opinion as well.

Breast augmentation

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5 surgeries in one year is an awful lot.  I think some of the opinions stated are very valid.  You may or may not be developing a capsule again.  If you are developing a capsule, then I suggest that you  may want to take the implants out for a while and then consider doing them again in about 6 months or not having them replaced.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

5 surgeries in one year

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Have you considered getting a second opinion? In twenty years of private practice I have never heard of anyone getting 5 surgeries in a year, let alone on the same breast. Unless something is done differently, the likelihood of a recurrence of your contracture is high.

Marcel Daniels, MD
Long Beach Plastic Surgeon

Capsule post breast surgery

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I myself like Dr. Virden also am an advocate of external ultrasound and massage.  You are a prime candidte for capsular contracture as you have had them in the past and the hematoma can also increase the chances of contractures.  I recommend you see your surgeon and ask about the availability of ultasound therapy in your area/.

Ernesto Hayn, MD
West Palm Beach Plastic Surgeon

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.