Could I be bottoming out on one breast, capsular contracture the other? (Photo)

I am almost 3 months post op, this was my second ba. My left implant has a bulge at the bottom and the bulge is tender, especially if I touch it or if I bend over. My right is higher, firmer, looks smaller. My surgeon does not see a problem with my left breast, says he will see me in 3 months about possible cc but he says my breasts were asymmetrical prior to surgery. I'm very worried. Is the bulge a normal part of the healing process? Could my right still settle? Should I be massaging?

Doctor Answers 24

Double bubble? Capsular contracture?

Thank you for asking about your breast augmentation.

  • I am sorry you are having these issues.
  • Your photo clearly suggests that the left breast is 'bottoming out' - that is, lies below the crease.
  • When this happens, the breast usually continues to move down. 
  • If it gets worse, your surgeon will need to correct it.
  • Your right breast appears not to have settled in place  - this is more likely that a capsule. 
  • Talk to your surgeon about strategies to help the right breast settle - and how to document the left implant's position so you can tell if it gets worse. 
Always see a Board Certified Plastic Surgeon
Hope you found this answer helpful. Best wishes

Discussing your concerns with your surgeon after surgical results are disappointing.

I would discuss your concerns again with your surgeon - your photos do not show very little, if any asymmetry, to account for your result.  Revision breast surgery can be difficult, but a board certified plastic surgeon who chooses to do revisions should understand this and should also understand your legitimate concerns with your result.

Could I be bottoming out on one breast, capsular contracture the other? (Photo)

It is likely that you had some asymmetry pre-operatively, as no two breasts are perfectly symmetrical.  From the photos you posted, it does appear that your left breast is bottoming out.  The right breast does not appear to be encapsulated but it's difficult to say from a photo.  Perhaps ask your surgeon about wearing a supportive underwire bra 24/7 to help support your left fold as you lay down more scar tissue and keep an eye on it.  Over the next few months, your breasts will continue to change in shape and get softer so re-evaluate then with your surgeon and go from there. Good luck. ac

Angela Champion, MD
Newport Beach Plastic Surgeon
5.0 out of 5 stars 5 reviews

Breast implant position concerns after breast augmentation

Hi,

Thanks for posting your question. I am happy to try and help you. It is important to remember that a board certified plastic surgeon will be your best resource when it comes to an accurate assessment of your situation, and concerns.

Having said that, you should go see your plastic surgeon.

Best wishes,

Dr. Michael J. Brown (Northern Virginia Plastic Surgeon)

Concerns After Breast Augmentation

Your concerns regarding possible bottoming out and capsular contracture can only be confirmed by an examination. In general it is best to have your original surgeon address these issues which he/ she may do after your next post-op visit. It is common practice to wait at least six months after surgery before considering revision surgery. However, it is not unreasonable for you to re-state your concerns sooner than that by communicating with the surgeon or the office staff. You could phone the office to ask about implant massage instructions and let them know about your other issues at the same time. 

David S. Motoki, MD
Draper Plastic Surgeon
5.0 out of 5 stars 16 reviews

Breast post-op follow up

On the left breast it looks like bottoming out which means that probably the implant goes lower than the inframammary fold. On the right breast does not look as presenting capsular contraction, but I cannot be sure from the photos. Asymmetries to the breast are the rule and nearly all women have asymmetries. So, very probably you had one and some grade of asymmetry has to be accepted even after an operation. My advice is to stay close to your doctor and try to have a good communication with him. He knows better than me and what is happening.

Capsular Contracture

It is hard form me to tell if in your pre-operative photos your left breast crease is in the same position it is in your postoperative photos because the breast tissue is in the way. If your folds were uneven to begin with then this makes sense that they would look that way when augmented. If they are even before surgery then maybe you should discuss with your surgeon what they think is the issue. Sometimes breast folds can be lowered and sometimes it is just what you had before surgery but it was not pointed out to you. The implant can also drop asymmetrically compared to the other side. I can not tell you if you have a contracture because that is a diagnostic test that can only be felt on direct examination.

Richard J. Brown, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 45 reviews

Implant Revision

I am sorry that you are having issues with your surgery.  At 3 months, this will not correct itself and you will need a revision if you want your breasts to be more symmetrical.  Without a physical exam, it is very hard to say that you have a capsular contracture on your right breast.  Your left breast implant is bottoming out and you have a double bubble.  Consider getting a consultation with a surgeon who is a breast implant revision specialist. Hope this helps!

Jules Walters, MD
New Orleans Plastic Surgeon
5.0 out of 5 stars 45 reviews

Could I be bottoming out on one breast, capsular contracture the other

Thank you for your question. Your still in your recovery period from your surgery. I would wait 6 months. Use underwire bra. If there is a significant difference in the infra mammary folds, after this time, then you may need a revision. A revison would entail a caspuslorrhaphy and internal sutures to elevated and fixate the infra mammary fold. Discuss your concerns with your Board Certified Plastic Surgeon. Best wishes.

Capsular Contracture and "Double-Bubble"

Regrading the left breast:
The profile view you included shows that there is definitely an early "double bubble" or "bottoming out" of the implant. Almost all breasts are asymmetric to some degree, but the asymmetry in your pre-op pics is not the cause of your issue.
The "Double Bubble" deformity happens when the implant falls beneath the natural breast fold. The fold persists as a slight indent in the skin, much like a seam in a quilted blanket persists even if a pillow pushes down beneath it on the bed. This will not correct with time, and likely will get worse given that your skin *appears* to be thin and lacking elastic recoil and that you have upgraded to a heavier implant which will be pushing down on this area constantly over time. The only way to slow the descent is to wear a very supportive bra with a well defined crease/wire at the level of the desired fold. But, this is simply a temporary "fix" for a structural problem which needs structural surgical revision. Keep in close contact with your surgeon.
My suggestion would be support bra for another 3 months to prevent worsening, and at the 6 month mark revision surgery to re-establish the correct fold, possibly with the support of a mesh such as Alloderm or Seri. Regarding the right breast:
Capsular contracture, unless severe, is something impossible to diagnose from a photo alone. Your surgeon would need to examine and feel the implant to make that call & determine whether or not intervention is needed. 

Good Luck!

Dr. Subbio



Christian Subbio, MD
Philadelphia Plastic Surgeon
5.0 out of 5 stars 52 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.