Is this capsular contracture 4 months post-op? Would I need surgery again? (Photos)

Question

I made an apt with my surgeon a little after 3 months post op about my concerns. Harding of my left breast, bleeding from the nipple when massaging it, and very painful when massaging. I would squeeze it but it wouldn't squeeze very much because of how hard it's becoming. He said it wasn't Capsular Contracture it was the muscle, to take vitamin E, and to keep massaging vigorously but it keeps getting worse. How much would it be to fix it if that's the case? (silicone, 560, Natrelle, Allergan).

Gerald Minniti, MD, FACS · Answer

Hello,You can see the affected implant is higher than it was a month ago, thanks to your photos. This is capsular contracture, the most common complication of breast augmentation, which most commonly occurs through peri-areolar incisions like the one's you have.  As you can see, implant massage neither prevents or treats this problem, nor does vitamin E.  Muscles do not cause these sorts of problems, but are frequently blamed by the surgeon. You may promptly stop massaging your implants. Based on what you claim your surgeon has told you, I advise seeking out second opinions from ABPS certified/ASAPS member surgeons expert in revision breast surgery. Best of luck!

Dallas Buchanan, MD · Answer

Thank you for your very good pictures and questions. It would appear that there has been a change in the wrong direction and one of the most reasonable explanations of what you describe would be capsular contracture. While this often can require revision surgery to repair, if it is earlier in the process (which you clearly are), then there are also medical treatments (Singulair, etc.) which have been shown to halt or even slightly reverse those changes and I would discuss this with your surgeon ASAP. If you refuse to acknowledge the problem, then you may miss the chance to treat it. There is no guarantee this will work but its worth a shot before considering revision surgery. Hope this helps!

Yuly Gorodisky, DO, FACOS · Answer

From your photos and description, it seems you probably have a capsular contracture. This may happen to anyone having a breast augmentation. It is caused by the body creating excess scar tissue around the breast implant. There are some nonsurgical treatments using ultrasound and medications, but if all else fails a surgical procedure to remove the scar tissue may be necessary. After having a capsular contracture, the chances of having another one are increased. The costs may be similar to the initial surgery or less. You should discuss this with your surgeon. Sorry you have to go through this. Good luck.

Daniel Barrett, MD · Answer

Dear Motherhood3,Capsular contracture affects people approximately one in 20.  No one knows exactly what causes it and what can prevent it completely. It's important for your doctor to use a minimal incision and a Keller funnel as a sleeve to protect the implant from touching anything before goes into the breast pocket.  Singulair has been shown to prevent it. IN case of a capsular contracture, you would need a surgery. The exact cost of revision surgery is hard to predict because it depends on a lot of factors (type of surgery, surgeon's experience, anesthesia, facility fee, city, etc.). It would be the best to call a few plastic surgery offices to get information. In LA area, the cost of breast revision surgery is 6K-18K.Daniel Barrett, MD, MHA, MS 
Certified, American Board of Plastic Surgery  
Member, Am. Society of Plastic Surgery

Gregory T. Lynam, MD · Answer

While an exam is needed for determining capsular contraction it looks like capsule formation to me based on your description. You do have asymmetry before and after surgery which is normal but it looks like your right breast fold and implant are significantly lower. To look better you will need revision surgery. There is an asthma medicine that you can try twice a day for capsule contraction. It works in about 30% of patients. While fine to use the Periareolar surgical approach has a reported higher risk of capsule formation compared to a breast fold incision. Good Luck!

Benjamin Chu, MD, FACS · Answer

It appears you have developed a lower pole capsule on the left breast.  This may be related to over use of the left arm shortly after surgery.  Generally scars take 6 weeks to form so I am assuming you injured your left breast around two months after surgery.  Tears in the capsule results from over use of the pectoralis muscle.  When tears of the capsule occurs blood pools in the lower part of the breast and can cause contraction in that area.  When the capsule of the lower breast occurs the implant get pushed up hence the higher position of the left breast.  Since its still early you may try Aspen high frequency ultrasound of the lower pole of the breast and wrapping of the upper pole to relax the scar of the breast.  If that does not work then you will need a revision of the left breast.  In the mean time don't further injure the breast by vigorous work outs.

Richard P. Rand, MD, FACS (retired) · Answer

The dramatic difference between 3 and 4 months with the implant riding up and looking fuller in the upper pole is characteristic of capsular contracture. Especially if it feels hard now. You will be needing further surgery to replace a new implant and remove all of the scar tissue.

Brooke R. Seckel, MD, FACS (retired) · Answer

Your history and the change in appearance between three and four months suggest a capsular contracture.  Revisit your plastic surgeon and if the he or she is not responsive seek a second opinion

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