Bottoming out or Capsular Contracture After Revision?

105lbs 5"5'. First BA in April of 07' I had elected to go with 350cc saline through the belly button, the results were beautiful for about 8 months when I noticed hardening of the right breast.It was obvious that I had a capsulor contractor. After the second surgery in April 09 We replaced both implants with cohesive gel silicon 500cc with capsulectomy done on the right breast. Then in December 09' had to revise the left breast that had bottomed out. Now 4 months later im not sure if it is bottoming out again or another capsuler contractor or both!

Doctor Answers 13

Revision breast surgery

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You are heading down the slippery slope of the multiply operated breast implant patient. There is a point where you will never have a good result because of scar tissue and tissue memory. You probably have one last chance for a decent, but not perfect, outcome. Make sure you are in the hands of the very best breast plastic surgeon in your area and listen to their advice even if it means going smaller. The photos might well indicate a recurrent cc on the right because of the elevation and flattening of the lower pole. Good luck with this! You're in a tough spot.

Contracture after revision

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Thanks for posting photos so we can TRY to give you a diagnosis and treatment options. First you must realize an in person examination is much better than an internet examine with photos.

Now I feel the right breast is capsuled and an inferior capsulotomy is a choice. If the right implant is a 500 cc than that is all I would do for this side. Of course I would drain this side.

For the left side, it appears as a bottoming out, kinda of. A side view would help, but with the frontal the view is not to unacceptable. If you like the left than either leave it alone or I could recommend repair the bottoming out via internal sutures or a combination of the mesh (Strattice).

Finally, I would inform you of the risks involved and may need more than one operation. Hope I have given you at least a game plan.

From MIAMI Dr. B

Bottoming out or Capsular Contracture After Revision?

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I am sorry you're having so much difficulty with your breast implants. This is not typical for breast augmentation. I believe the correct sequence of procedures was done, in that, during your second procedure the implants were changed to silicone and placed in a submuscular position.
Capsular contracture is not uncommon after saline breast augmentation with implants placed subglandular (above the muscle).  Compared with saline implants placed above the muscle, breast  implant capsular contracture is less when silicone implants are placed in a submuscular or under the muscle position.
Based on your pictures I would say you definitely have bottoming out of your left breast implant. To fix this you have several options;  you could either raise  the left breast implant (inframammary) fold or lower the right breast implant (inframammary) fold. Another alternative is to do a little of both.
Concerning your question regarding capsular contracture, it is difficult to say if you definitely have breast implant capsular contracture. If you have pain in the breast and firmness of the breast, you probably have a Baker Grade 2 or 3 capsular contracture.
If you were to undergo surgery I would suggest the following. If the both breast hurt,  I would therefore suggest bilateral capsulectomies for bilateral breast capsular contracture. In addition, I would go with a slightly larger implant on both sides and lower the right implant fold and slightly raise the left implant fold. I would continue with silicone implants in a submuscular position. Good luck with your surgery.

J. Timothy Katzen, MD, FACS
Los Angeles Plastic Surgeon
5.0 out of 5 stars 254 reviews

Revision breast augmentation.

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1) Just going by your picture, you don't have "bottoming out".

2) You may well have contracture of the right breast. The right fold is much higher than the left.

3) I recommend smaller breast implants.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Your infra-mammary fold is lowered too much

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The inframmamary is too low over the left breast. Your implants are above the muscle. The other issue is the size of the implant. You have too big a implant and you can see the extension of the implant edge in the midline. The diagnosis of the capsular contracture is very hard from the pictures that you have attached. I would recommened that you see your doctor and ask him about this. Your story of implant problems is very common with transumbilical augmentation.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.7 out of 5 stars 152 reviews

Bottoming out or capsular contracture after revision?

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Hello! Thank you for your question! Physical examination will determine if you have capsular contracture. The look and feel of hardness surrounding your implant is seen and/or felt. At its worst, you experience pain. It may also cause distortion of your breast. What has caused it will be in question.  Given your photos and description, it may be a recurrent capsular contracture. 

Your surgeon will likely recommend implant massage and may add the medication Singulair. If these fail, surgical correction may be suggested. It is a matter of surgeon preference as well as what is seen during your procedure that will determine whether or not a complete capsulectomy is performed. If significant capsule formation is seen intraoperatively, a full capule removal may be warranted with a drain in order to completely remove all of the tissue and allow better adherence of your breast back to its normal anatomic position down on your chest wall. Irrigating with certain medications may also be if benefit. If minimal contracture is seen, it may be possible to leave the capsule, or place cuts within the capsule to allow better adherence. It truly is dependent on what is seen with your capsule and the issues that may be causing you to have such a procedure (e.g., contracture from rutptured implant vs pain vs simple pocket adjustment, etc).

Without knowing your issues and without an examination, it is difficult to tell you what may be the best thing for you. I tend to favor performing capsulectomies in order to create a fresh pocket, reshape the pocket, allow better shape and adherence of the overlying breast. I would discuss your issues with your plastic surgeon who will assist you in determining the right modality for you. Hope that this helps! Best wishes!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 28 reviews

Capsular contracture or bottoming out of breast implant

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?Thank you for your question. Obviously it is important that you see your plastic surgeon so that you may be examined and a proper diagnosis made.

My guess looking at your photograph would be that the right breast is forming a capsule which is constricting the breast and making at higher than your left breast. You should be able to determine if this is a capsule by simply feeling the breast and feels harder on the right than the left and you likely are getting a capsule. Again be sure and see your plastic surgeon for an accurate diagnosis

Capsular contracture

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Looking at photos without exam it is impossible to tell, but it appears you have a capsular contracture on the right. If so, the right implant should be tight and hard. If not then it might need revision to drop it down a little.

Revison and Revision

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.Without examining your breasts, we are all only guessing. Are your implants the same 500cc size. The right appears smaller and may have capsular contracture. The left appears larger and lower. The surgery I recommend if the above is true takes experience and a good plastic surgeon. I would decreased the size of your implants, do a capsulectomy on the right. On the left would require implant exchange and a GOOD internal capsulorraphy with a support bra for six weeks. Placement of a collagen sling would be considered but is expensive

Richard Linderman, MD
Indianapolis Plastic Surgeon

Implant issues

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From the photo, and I would have preferred to see your hands down at your side and not lifted, the right one seems tight.

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

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.