5 1/2 month post op afraid of left implant encapsulated over the muscle (Pohto)

Question

Oct 12, 2023 i got 510 cc silicone high profile in both boobs. I started very very small, around an a cup. Now I believe i am a solid small D. My right implant has given me 0 issues. My left has felt a little more firm than right, and seems to be its a little more circular? The pain is around 5 out of 10 Most days it doesn't hurt. Im not sure why it is not dropping the correct way? I am scared i messed something up in the left implant.

Daniel Barrett, MD · Answer

Dear corrinenc,
I understand your concern. However, without a proper assessment, it would be difficult to determine what is wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Tyler Frew, MD · Answer

Hi there,
It could be the beginning of a capsular contracture but you will need a physical exam to confirm this. Hard to tell fully from the photos but your left breast may also be bottoming out vs laterally displaced. Again, a physical exam by the surgeon could help clarify the issue. 
All the best

Dana Goldberg, MD · Answer

Encapsulation is rare in the first six months after surgery, but I’ve had a few patients developed it. In studies, it is more common above the muscle than below.

If it is capsular contracture (or “cap con”), there are some ultrasound based physical therapy protocols that can soften it. Also, some evidence shows that singulair can be taken by mouth to soften the capsule.

If those options do not work or if you do not want to try them then it is a wait-and-see game. Cap con can stop and stabilize, or it can progress. In rare cases, it can sometimes even seem to reverse itself.

If, in six months, you still have concerns, you may require surgery to remove the capsule. In my practice, I incorporate antibiotics and allograft placement into revision cases to minimize the chances of it coming back. Stay in close touch with your surgeon, since several of the silicone implants come with a warranty for cap con for a few years after surgery.

Camille Cash, MD · Answer

It is common for the breasts to heal at different rates.  However at 5 1/2 months post op you should not be experiencing pain or tightness regularly.  It's best to return to your surgeon for an evaluation and discussion of your concerns.

Connie Hiers, MD, FACS · Answer

You may have developed a capsule on the left side. go back to your surgeon and be checked. Sometimes it can be improved without surgery if you do not delay.

Mats Hagstrom, MD (license on probation) · Answer

There are no obvious issues or abnormalities seen on your pictures.
I’m not sure if your concern is the discomfort or the appearance?
I suggest you follow up with your provider.
There are three variables to determine the outcome of breast augmentation surgery.
The first is the patient’s candidacy for the procedure. The second is the choice of implants in regards to size shape and type. The third is the surgeons ability to place the implants in the correct anatomic location.
 Candidacy is influenced by variables like breast divergence, which you have.
It’s also affected by breast asymmetry, breast droopiness, breast position on the chest wall, and other variables.
Implants selection is also an important part of high-quality outcomes.
Working with excessively large implants will lead to an increased risk of complications, undesirable side effects, and need for revision surgery.
Choosing implants that are much larger than the natural breast diameter will violate the natural breast periphery, and this leads to secondary problems.
Bigger implants always lead to more issues.
My preferred method is generally sub, pectoral placement of implants, but there are those who have good success with placing the implant above the muscle as well.
 I don’t see anything wrong with your outcome from the pictures or information you’ve included.
Follow up with your provider and have him or her address your concerns.
Best,
Mats Hagstrom, MD

5 1/2 month post op afraid of left implant encapsulated over the muscle (Pohto)

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