Do I have capsular contracture, the muscle holding the implants or do I need a lift? (Photo)

I'm 4months post op. 550 silicone under the muscle. I had saggy breast prior to surgery. After they settled week 3 and 4 they were beautiful and I was happy. They still feel soft and moveable at 5 months but they appear droopy. The skin hangs over the implant. It's worse on my right side. I'm having right muscle pain that feels really tight over my chest and armpit area. Do I need more time for the muscle to heal and drop the implant more into pocket? Capsular contracture? Or a lift?

Doctor Answers 6

Breast droop

It looks like you have a bit of a waterfall like appearance that can be seen when the breast falls over the augmented muscle usually due to pre operative droop and sometimes associated with scar tissue around the implant (contracture) 

At this point I would wait for at least 6 months post op  and then have your surgeon re- assess for options.  The next step is critical and you need to fully understand your options which may include;

breast lift or re-positioning the implant in the subglandular position or converting this to a dual plane breast augment.  No absolute right or wrong answer and You need to understand options and participate in the decision making 

Good Luck


Baltimore Plastic Surgeon
4.4 out of 5 stars 29 reviews

Redo breasts augmentation

Dear L.

    Thanks for submitting your pictures. On your before picture you appear to have level 2 ptosis (droopiness) and large areolas and that condition, not only continues on you post operative pictures , but rather getting worse as it could have  been predicted.

    If you were my patient, I would have recommended to you breasts augmentation with mini lift and areola reduction (donut, Benneli ). This would have given you beautiful and perky breasts with more attractive areolas.

   Unfortunately, you present condition will not improve on it's own  or with time.  The only way to help you achieve your desired breasts is redo breasts augmentation that includes caosulotomy ( scar release ) or capsulectomy ( scar excision ) if you have Biofilm ( bacteria embedded in the capsule and on the implant ). Mini lift procedure will be strongly beneficial  to you.

   Always consult with experienced board certified plastic surgeons who do lots of redo breasts augmentation in accredited surgery center for your safety. Most importantly, check the before and after pictures in the photo gallery, to make sure that they are numerous, consistent and attractive with nice cleavage , perky, symmetrical and natural looking. Also, check the reviews on 'RealSelf" for ratings and positive experience reports.

                                      Best of luck,

                                                           Dr Widder

Shlomo Widder, MD
McLean Plastic Surgeon
4.8 out of 5 stars 124 reviews


I can not be a 100% sure that you do not have a capsule without an exam in person. If I go just by your photos, it looks like you have some sagging and need a lift.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews


If you like the implant position overall and the implants are soft, then your best option is a vertical lift to correct the excess skin falling of the breast implants and position your nipple/areola slightly above the apex of the implant.  Best wishes, Dr. T. 

John Michael Thomassen, MD
Fort Lauderdale Plastic Surgeon
4.9 out of 5 stars 49 reviews

Implants, capsule or lift.

Thanks for your question and the photos. I am sorry to hear about your concerns. It is still possible to have some discomfort even 5 months after surgery, so that alone doe not mean capsular contracture. You PS will be able to give you a better idea by examining you and feeling how firm the breast is.  Even larger implants do not always fill out loose breast tissue. If you feel too droopy then a lift can always be added. It is usually worth waiting at least six months to be sure the implants have settled. Just a word of caution, even with a lift you will likely regain some droop because of your natural starting volume. Natural breast tissue even with implant s wants to go south, but in my opinion a little droop is a good thing and makes the implants look more natural.

Hope this helps.Share your concerns with your PS.

Best wishes.

Adam Tattelbaum, MD
Washington DC Plastic Surgeon
5.0 out of 5 stars 104 reviews

Breast sagging requiring breast lift.

Thank you for your question and photos!

First off, it does not seem like you have capsular contracture.

In breast augmentation, capsular contracture refers to tightening of the scar tissue that normally forms around the implants resulting in hardened, painful, and abnormal looking breasts with varying degrees of severity. The capsule is fibrous tissue that naturally forms when anything foreign is placed in our body – this happens with heart devices as well. However, when there is too much inflammation, fluid collection, or bacterial contamination, the fibrous capsule can start to scar down further and contract.

There are 4 grades/levels of capsular contracture:

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.

What you are experiencing is sagging of the breasts resulting in the appearance that the breast tissue is hanging off the implant. This happens because of pre-existing breast sagging, because the chosen implant does not fill the breast envelopes adequately, and because of natural aging and stretching effects of the skin.

Since you had pre-existing sagging of the breasts, and it was not fixed, the implants are speeding up the sagging process.

A breast lift (mastopexy) will fix the problem.

Please have an in-person consultation with your plastic surgeon to share your concerns and goals.

Hope this helps.

Martin Jugenburg, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 457 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.