Breast Implant Damage After Car Accident

Question

I had a breast augmentation in June of last year. Everything looked great until after a car accident recently. The damage to my car was over $5,000. Since I didn't have any broken bones, I wasn't sure it was caused by the accident. My right breast has dropped. I have no pain in the breast, and it is very soft. My left breast has not changed at all. I have before and after pictures of my breast in clothes. Your help is greatly appreciated. P.S. I did follow up with my surgeon, and only got to see his assistant that day. She prescribed steroids thinking my left breast had a capsular contracture, and recommended that I do breast massages only on my left breast. My left breast isn't the issue here; it is my right breast that changed overnight as you can see in the before and after pictures.

Steven H. Williams, MD · Answer

Thanks for the question.
It is difficult to answer without examining you and seeing the issues you're concerned about.
After trauma there are several issues regarding implants:
First - Are the implants intact or has the trauma caused a leak? With saline implants this can be relatively obvious as deflation occurs almost immediately. With silicone implants this can be harder to detect.
Second - Has the envelope (including the capsule or scar tissue) around the implant ruptured or torn? This can cause asymmetry in implant positioning. Signs (in addition to the asymmetry) can include a tearing or popping sensation at the time of trauma or bruising around the breast.
Third - Has there been bleeding around the implant?  This can result in a hard breast as a hematoma forms around the breast.
You should see a board certified plastic surgeon to evaluate your implants.
I hope this helps.

Michael Constantin Gartner, DO · Answer

There are several things that may have happened. For example, the scar tissue around your right breast implant may have released, making your breast drop. The implant may have ruptured as well. Either way, you should see your surgeon. If you say that your left breast hasn't changed at all, then it's probably not capsular contracture. Either way see your surgeon, not the assistant!

Hayley Brown, MD, FACS · Answer

From your photo, it looks like you may have a history of mild to moderate capsular contractures (scar tissue) on both sides. This shows up as firmness of the breasts, visible definition of the roundness of the implant, and oftentimes a higher, less saggy looking breast. Some patients like mild contractures when they are symmetric. Trauma to the chest can potentially "tear" part of the capsule (scar tissue), which subsequently releases it, so the breast then feels much softer and looks potentially lower or more ptotic (saggy). This is usually associated with mild transient bruising and swelling on the affected side and discomfort at the time of the injury which resolves. In addition, the implant can rupture. If the device is silicone, the best way to diagnose a rupture would be MRI. With saline, you usually see a size decrease. Regardless, the visible asymmetry in your central cleavage area, which shows in clothes, likely will need to be corrected with surgery if you don't see improvements with conservative treatment such as massage over a few months.

David Shafer, MD, FACS · Answer

VVN,
It is hard to tell from your description if the car accident had anything to do with it.  If you were not hit in the breast area or had any force from the seatbelt on the breast region, then it is hard to say it was from the accident.  However, any unilateral (one sided) change is curious and you should see your surgeon for an evaluation.  Good luck.

Leonard Lu, MD · Answer

It is difficult to tell based on your picture, but I recommend you pay a visit to your surgeon. It is possible it is related to your accident, but there are other reasons that the right breast may have dropped. Good luck!

Shahram Salemy, MD, FACS · Answer

It's difficult to know what exactly is happening, but it may or may not be related to your car accident.  The weight of the implant can affect its position over time, as can capsular contracture (your body naturally creates a scar around the implant, called a capsule, and in some patients that capsule can narrow around the implant, or contract-- this can be only on one breast and will cause the implant to slightly elevate).
It would be wise to have your surgeon examine you for capsular contracture or rupture (either of which can be corrected) or if this asymmetry is due to bottoming out of your implants.  
In all likelihood, however, if an issue exists with your implants, it can be improved.
Best of luck,
Dr. Salemy

Kenneth R. Francis, MD, FACS · Answer

VVN,
Your description of your breast augmentation history and your recent trauma with subsequent change in the breast  begs the question of whether the implant was damaged during the accident. 
Seven or eight months out from surgery is an unusual time for one implant to suddenly drop. Usually, most of the implant settling has occurred by six months. I'm not sure what the 5,000 damage means, as a small amount of damage can cost a lot of money these days. 
You don't mention whether you received any trauma to your breast in the accident. An impact strong enough to damage an implant would likely cause you pain and bruising in the breast. I suggest that you return to your surgeon for a full evaluation and advice as to how to correct the asymmetry in your breasts. Good luck!

Scott E. Kasden, MD, FACS · Answer

The right breast implant is sitting lower than the left at this point. Is this from the accident or just the way you healed? We can't say. Will the other side drop too? Don't know that either. 
I recommend that you speak with your surgeon. Decide which side you like better, and come up with a plan and a timeline. He may tell you to wait a few months and it will be fine, or he may tell you that you need a small surgical procedure to fix the minor asymmetry. Either way, it will be an inconvenince, but not a major problem.

Hisham Seify, MD, PhD, FACS · Answer

It is hard to tell without a clinical exam. I highly recommend that you see a board certiffied plastic surgeon in your area. He will be able to detect implant related problems versus a capsule procedure. In few cases, imaging might be needed. It could be simply a bottoming out of your implant which could be fixed with a small procedure. Hope that helps!

Steven Wallach, MD · Answer

I am not sure that your concern is related to your car accident. The breasts dropping is normal. If one is much higher than the other, then is could be the result of one bottoming out, or a firm capsule in the opposite one. It is difficult to give you an answer without examining you and/or seeing better photos.

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