Is It Possible to Have Capsular Contracture After Only 4 Weeks Post Op?

Question

I had sub-muscular silicone impants 4 weeks ago. My left breast has softened nicely, but my right is still hard. Could this be capsular contracture?

Jerome Edelstein, MD · Answer

In capsular contracture, the tissue around your implant can potentially tighten, and this is what squeezes the implant to make it feel harder. If you've just recently noticed that your breasts have changed in shape, feel, and how they project from your body, then you're right - you could be developing capsular contracture. While you can feel for yourself for any changes that indicate capsular contracture (signs include hardness, swelling, pain, and a rounder, more ball-like shape), please book an appointment with your surgeon who may examine you to see if it actually is. Your examination sometimes can involve an ultrasound, mammogram or MRI. The sooner you do this, the sooner you can be diagnosed and treated. Earlier detection is always better. Treatments for capsular contracture include medications, therapeutic massage and stretching, as well as implant removal/replacement. On the other hand, however, it can also mean that your right breast hasn't settled yet since you're still early in your recovery.

S. Larry Schlesinger, MD, FACS · Answer

Four weeks after surgery, if your breast is hard on one side, early capsular contracture can certainly be a diagnosis.  Bob Ersek, M.D., of Houston, Texas, wrote a landmark paper on a "fibrous storm" where under certain conditions a capsular contracture can occur as early as a week after surgery. I am sure your plastic surgeon will want to see you and evaluate the tight breast, but the short answer is "yes", you can have a capsular contracture for multiple reasons at one month.

Raffy Karamanoukian, MD, FACS · Answer

The tightness that you are experiencing may be a result of swelling, a hematoma, or early capsular contracture. An examination is absolutely essential in order to minimize early development of capsular contracture. At the 4 week interval, true capsular contracture vs. normal tissue capsule formation, are still viable options. Surgery90210

Otto Joseph Placik, MD · Answer

In general, it is difficult to diagnose a capsular contracture at this point because scar tissue is normally forming at this point up until 6 weeks after surgery. However, it may be easier to diagnose after 6 weeks if it continues to remain firmer than the other side. There may be a variety of other reasons while one breast is firmer than the other which include hematoma, seroma, swelling, size difference, implant volume differences, etc

Jose M. Soler-Baillo, MD, MS · Answer

A firm breast 4 weeks after surgery can be several things:

	1- Most commonly it is just tissue tightness. Larger implants in tight pockets will feel very firm for up to 2 months after surgery. The breast on the side of hand dominance( right vs left) will usually soften first, since the patient uses the muscles on that side significantly more.

	2- A blood collection (hematoma) can also make the breast feel firm; Bruising would be obvious.

	3-  An early capsular contracture can begin to be felt around this time, and will continue to worsen. If the tightness worsens over the next two weeks, you might have a capsular contracture.

Jeffrey Zwiren, MD · Answer

There are many suspected causes of a capsular contracture but the most likely causes are implant contamination, bleeding and infection.  Surgical technique is critical as prevention is the cure for capsular contracture.  The risk of a capsular contracture when implants are placed above the muscle is in the 20 to 30% range.  When the implant is placed either subfascial or sub muscular the risk is in the 4 to 7% range.  The no touch technique was first described in 1991.  This means avoiding any surface contamination of the implant during insertion.  The no touch technique combined with irrigation with antibiotic and betadine solution as well as use of a funnel has greatly decreased the risk.

Paul Gill, MD · Answer

It would be hard to determine without an in office exam.   Thank you for your question.  Capsular Contracture is one of the main risks of breast augmentation.   Classic signs are:

	1.  hardness/tightness of the implant
	2.  change in implant position (typically migrates towards the collarbone)
	3.  increased pain and stiffness on the associated side.
	Based on your description, you should see a board certified plastic surgeon for evaluation of capsular contracture.    If present, I would recommend a capsulectomy (removal of scar tissue) and implant exchange. 
	Factors to consider:
	1.  If your implants are above your muscle, you may want to consider switching to underneath the muscle, which lessens the risk of capsular contracture.
	2.  If your implants are above the muscle and you desire to keep them there, you may benefit from the use of a textured implant.
	Dr. Gill

Steven Wallach, MD · Answer

It is unlikely that you have a capsular contracture at four weeks post-op from a breast augmentaion. Speak to yoru doctor but you probably have to give it a few months to settle.

Mark Broudo, MD · Answer

Though still very early, this could be a sign that you are developing capsular contracture. Aggressive massage at this point along with ultrasound therapy can make a big difference. Definitely consult with your surgeon.

Peter A. Aldea, MD · Answer

Regarding: "Is It Possible to Have Capsular Contracture After Only 4 Weeks Post Op?  I had sub-muscular silicone impants 4 weeks ago. My left breast has softened nicely, but my right is still hard. Could this be capsular contracture?"

	While capsular contracture is theoretically possible at 1 month after surgery, that is not likely. What is a more plausible explanation is that the implant pocket was under-dissected resulting in a "tight fit". In such cases, specific massaging may help. Please, discuss it with your surgeon and make sure you do what he/she advises you to do.

	Dr. Peter Aldea

Is It Possible to Have Capsular Contracture After Only 4 Weeks Post Op?

Answers (10)

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