Is this capsular contracture or is this normal? (Photos)

I am almost 4 months post op. I had a mastopexy and augmentation with 300cc round implants under the muscle. I am extremely happy with the left breast however the right breast has looked like this and only gotten more noticeable since 1 week post op. The nipples seems to be lower than the left and the weird bubble is not noticeable when my arm is elevated. Is this normal or can it be fixed?

Doctor Answers 4

Possible capsular contracture post BBA

If this is your first breast augmentation procedure then it would be highly unlikely you have developed capsular contracture at under 4 months post op. There is a clear difference between the two breasts and it may be that you have developed some scar tissue between the implant and your skin or the muscle. I would recommend you return to see your surgeon for a clinical examination to get more information as to what may be causing the deformity. 

Capsular contracture

Thank you for your question.  I can appreciate the contour difference you are describing in the photos.  However, I think you will require a proper in-person exam to determine the cause

Capsule contracture is best determined on clinical exam

There are a couple of things that I can see in your images that might resemble capsule contracture, but then again, given your very thin tissues, the fact that you also had a vertical breast lift, and the fact that you are still healing at 4 months post-op, it is also possible that the things we are seeing are not capsule contracture.  You certainly appear to have some distortion of the shape of your breasts, more on the right than the left, and they are very distinctly round, and the implants are very noticeable.  These things can happen with capsule contracture, to be sure, but they also may be due to the many other factors involved in your anatomy and surgical technique.  If your breasts are soft and pliable, and your capsules produce no restriction of movement of the implants, it is very unlikely that this issue is capsule contracture.  This can only be determined in person by your surgeon on exam.  Other things that could be happening are loss of volume or scarring in the breast tissue itself as a result of the lift, which may have nothing to do with the capsule.  This is something that revisionary surgery, such as repositioning of breast tissue or fat transfer may help.  Discuss these concerns with your surgeon and let him or her evaluate the capsule clinically.  He or she will be able to decide what is going on and what the best course of action is from here.  Best of luck.

Is this capsular contracture or is this normal?

The hallmark of contracture is one breast becoming firm and moving up towards your collarbone causing the nipple to rotate downward and can even be painful. Capsular Contracture is not well understood, and a single cause has not been identified. Leading theories include: subclinical venous bleed, low level bacterial contamination and/or biofilm, lint contamination from sterile drapes and genetic predisposition. Since the cause is unknown, treatment typically involves addressing all possible causes. There are four grades of contracture. Grade I is normal, looks good and feels soft and does not require treatment. Grade II feels firm but otherwise looks good. Grade III feels firm and looks distorted at rest. Grade IV feels firm, looks distorted at rest and is painful. Aggressive massage +/- Leukotriene Inhibitors can improve/soften Grade II contracture but in my experience rarely improve the superior malposition present in Grade III and Grade IV contracture. These respond best to surgical revision/capsulectomy and implant exchange. I would recommend to return to your operating surgeon for an in-person examination so they can better diagnose what's going on. Best of Luck.

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