What are the early symptoms of capsular contracture?

Question

I had breast augmentation approximately 2 months ago, and recently started feeling some firmness in my left breast, though it appears normal and symmetrical with my right. When I push on the breast, the tissue is soft but the implant feels akin to a ball moving around inside, whereas my right feels soft and I can hardly tell where the implant ends and my breast tissue begins. The left also feels somewhat tender when I apply pressure and then release it. Could these be signs of early capsular contracture?

Jaime S. Schwartz, MD, FACS · Answer

I appreciate your question.You may be experiencing the start of capsular
contracture . This is when  the collagen-fiber capsule tightens and
squeezes the breast implant . It is a medical complication that can be painful
and may distort the breast implant and the breast . The degree of capsular
contraction is graded using the four grade Baker scale : grade I-IV:Grade I — the breast is normally soft and appears natural in size and shape.Grade II — the breast is a little firm, but appears normal.Grade III — the breast is firm and appears abnormal.Grade IV — the breast is hard, painful to the touch, and appears abnormal.I would recommend you follow up with your plastic surgeon so he/she can examine you and recommend the most appropriate treatment plan at this time.The best way to assess and give true advice would be an in-person exam.Please see a board-certified plastic surgeon that specializes in aesthetic and restorative breast surgery.Best of luck!Dr. Schwartz

Larry S. Nichter, MD, MS, FACS · Answer

You should check with your surgeon as the only way to really know is an in person examination of your breasts. It is impossible to help you without a consultation. Capsular Contracture is a condition where the capsule around the implant thickens and squeezes the implant making it hard and often changing the shape and position of the implant. It is more common in nicotine users (e.g. smoking or nicotine patches or gum). Effective treatment of the capsule frequently involves completely removal of the capsule (capsulectomy), and occasional incisions in the capsule may be somewhat helpful (capsulotomy). In the past, closed capsulotomy, in which the breast is squeezed until the capsule breaks, was used. Currently, most doctors avoid this technique because of complications associated with the technique and because the implant companies will void their warranty if this technique is used. At times it is necessary to change the position of the implant, either above or below the muscle, depending upon the initial position, changing the implants themselves and, on occasion, the use of Acellular Dermal Matrix (ADM) may be required to prevent continued problems. Although the published risk of capsular contracture is approximately 9-11%, in our practice it is somewhat lower after initial implant placement. Once capsular contracture occurs, the risk of problems with secondary surgery rises to between 25% and 40%. The use of Singulair and Vitamin E may be of benefit. If you had a Sientra Textured Implant placed as a primary procedure and a contracture occurs in the first two years after primary augmentation, then their implant warranty may apply.

Rukmini S. Rednam, MD, FACS · Answer

Hello Molly,It is possible that you have very early signs of capsular contracture though 2 months would be a very early presentation. When caught early capsular contracture can be diminished somewhat by consistent massage and treatment with some medications with anecdotal success.  The most important step right now is to communicate with your plastic surgeon about your concerns as he/she can evaluate you and best advise you.Best of Luck!Dr. Rednam

M. Scott Haydon, MD · Answer

Thanks for your question and I'm sorry that you are having an issue. The overall rate of contracture is 6% across the board. There are certain things like implant size and position that can affect it. When it does occur the scar tissue around the implant tightens and it feels more firm. Aggressive massage is used with early firmness in smooth round implants. Singulair is a medication that anecdotally has been used with success in some patients though there is no data to support it. This is best monitored with your surgeon. Best of Luck!

Scott W. Harris, MD, FACS · Answer

Briefly, the answer to your question is yes, you could have an early capsular contracture, but don't worry yet. You must go see your doctor and be examined. We can usually tell what's going on and can help. There are exercises and medications that can help, even if you do have a contracture. Good luck!

Bradley A. Hubbard, MD · Answer

Thanks for your question. I have to admit I am a bit confused by your description. You have mentioned that the left breast is firm (sign of capsular contracture), but then you mentioned that the implant is moving around more (sign of the capsule being to large). There is a good chance I am not understanding your comments, because to me these symptoms seem to be opposites! If the left breast was larger I would be concerned about a seroma or fluid collection: large breast, firm, increased implant motion. But that can't be the case, because you mentioned that they seem to be the same size. I think that you are way to early to have capsular contracture. I think you are experiencing asymmetric rate of implant settling. The other possibilities are fluid collection vs enlarged capsule size on the left. You should schedule an appointment with your PS to figure out what is going on and how to treat it. There is a very strong possibility that nothing is wrong at all. That this is just normal healing. Best of luck!

Sheila S. Nazarian, MD · Answer

At 2 months, you are probably too early for capsular contracture. However, only an in person exam can tell for sure. Make an appointment to see your surgeon for your peace of mind. Best, Dr. Nazarian

Ravi Somayazula, DO · Answer

Your description leads me to believe that it perhaps may be early contracture. However, aggressive massaging can help prevent it from worsening and some medications can help but not clinically proven. Close follow up with your plastic surgeon will be key to keep a close eye on it. regards,Dr. Ravi Somayazula

Jourdan Gottlieb, MD · Answer

The earliest sign is typically firmness in one or both sides. A visit to your surgeon for an examination is the appropriate next step from here. Two months is a bit early for CC, so I suspect that will not be the diagnosis. All the best.

Robert N. Young, MD, FACS (retired) · Answer

The first sign you'll usually notice is firmness of the breast. Certainly when one breast feels significantly different than the other, it's something you'll want to bring up with your PS and have him/her examine. He/she may recommend a form of breast massage which can help prevent further constriction, but it is important to first have an examination.

What are the early symptoms of capsular contracture?

Answers (10)

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