Is it capsular contracture and what can be done about it? (photos)

I have under the muscle silicone implants for a year and a half. Resently I noticed my breast was hardening, changing shape and pain. My PS hardly acknowledge this problem. She said it felt soft, looked good, was barely smaller then the other and it's hard to tell weather it's from breast changing during nursing or contracture. My PS seemed upset I felt a there was an issue. She said to lay on mychest an rolling back/forth. It is incredibly painful I had to stop. Is there somethig else I can do?

Doctor Answers 6

Capsular Contracture

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The changes you have noted resemble CC. It would be best to be examined in person by another board certified Plastic Surgeon if your own is not responding to your concerns.

All the best

Capsular contracture

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It certainly looks like you have a capsular contracture.  It's not an emergency but the only treatment that truly fixes this problem is surgery.  Remove the scar tissue (capsulectomy) and place another implant.  

Capsular Contracture

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Find another surgeon. Not acknowledging the obvious is either dishonesty or incompetence, neither quality you want in your surgeon.  You have cc, and need a revision surgery through an inframammary incision to remove all the scar capsule in one piece, along with the implant. Compressing your implants with your body weight, or a more systematic approach of implant massage neither prevents or treats cc.  Go visit a few ABPS certified/ASAPS member surgeons who specialize in revision breast surgery. 

Contractures can develop anytime

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down the road following an augmentation and what you describe and from the photo you provided, it certainly looks like you may have one forming.  Your surgeon telling you to lay on your chest suggests she is aware of this and is hoping it will not worsen.  As for what to do, there are unproven interventions like Aspen ultrasound (I would want a guarantee before spending money on that) or use of anti-asthmatic drugs such as Accolate.  Otherwise, its waiting to see what occurs and if it is a contracture, it will progress with further distortion of your breast at which point surgery is your best option.

May have Capsular contracture, but needs in-person diagnosis

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You must be concerned about this and that is understandable.

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.

You can know about the capsular contracture using these classifications and applying them to your case. In your case, the difference in breasts is visible, and I am assuming the problem is with the right breast. If so, then it may very well be capsular contracture (above Grade III) as it looks contracted, and you describe pain as well. Note that you will always have to get anything checked with your or another board-certified plastic surgeon for accurate diagnosis. If your plastic surgeon is refusing to acknowledge the problem, then have a more direct and open conversation with them to share your concerns. If you have pictures from before the contraction occurred, then show it to them as pictures don’t lie. Remember that for dealing with conflicts, focus on the problem and ask them to work with you while using elements of respect and transparency to manage differences.

In case you do have capsular contracture, then you may require surgery for anything above Grade 2. There are two methods for surgical correction: removing the capsule (capsulectomy) and releasing/tearing the capsule (capsulotomy).

If there is still a communication problem with your surgeon, then approach another local surgeon and be transparent with them regarding your current situation.

Hope this helps.

Second opinion is in order

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Since your surgeon is not sensitive to your concerns, it would appear that a second opinion from an experienced beast surgeon is in order.

Marcel Daniels, MD
Long Beach Plastic Surgeon

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.