Is This Capsular Contracture? If So, What "Baker" Grade? How Long to Take Singular?

Surgery 1-27-2011.Told Dr about firm breast at 4 mos postop, again at 5 mos postop.Singular scrip at 5 mos, no improvement at 6 mos appt.Is this capsular contracture or pocket issue?What grade CC?Will singular help this far "gone"? No insurance so meds cost $160/mo. 450cc gummy bear submuscular implants - i'm 5'5" and 135lbs,very active.Want to see if meds are worthwhile or if I should just save for new surgery now - and what is estimated cost of revision? Original op cost $5995 inclusive of OR

Doctor Answers 11

Is This Capsular Contracture? If So, What "Baker" Grade? How Long to Take Singular?

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Thanks for posting photo. And YES you have a cc but to grade can not tell over the internet. You need revision surgery with open capsulotomy or ectomy and lowering the inframammary fold. I wonder if you were asymmetric before? The fee paid for silicones is very reasonable. In my practice I charge for costs to re operate. In MIAMI I would charge $2500. 

Fixing breast asymmetry

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Not knowing what you started with or exactly what was done at surgery it is impossible to say how/why you ended up with this result. The posted photo shows asymmetric breasts with the left nipple lower than the right, the whole left breast hanging lower than the right including the contents of the skin envelope. I suspect the left inframammary fold is lower than the one on the right.  It is very likely that you were asymmetric before surgery even though your description makes it sound like you developed the assymetry in the months following surgery. In that case the surgery magnified the asymmetry. The only certain thing is you will need further surgery to improve the symmetry and taking Singular is a waste of time and money. The appropriate surgery could include capsulectomy, skn excisions to reposition the breasts etc. depending on the physical findings and history.

I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles Plastic Surgeon

Capsulr contracture

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Your breasts look asymmetrical and assuming that they didn't early postop it would most likely be from a capsular contracture on the right side (the higher one).  I am personally not impressed with non-surgical treatment for cc and I would imagine you will need a capsular realese/excision and a new implant.

Breast asymmetry after breast augmentation

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Because of your concern with breast asymmetry, I assume that your breasts were relatively symmetric prior to surgery.  Does the right breast feel more firm than the left?  At 6 months, the scar tissue is well formed and will not noticeably stretch with massage.  Singulair is not of proven benefit.  The implant should be surgically released and the implant exchanged.  Perhaps the surgeon will offer you a discount for secondary surgery.

Elizabeth S. Harris, MD
San Antonio Plastic Surgeon

Use of Singulair to treat capsular contracture

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Dear San Antonio,

Please save your money. Like my colleagues before's hard to say what happened without knowing what you looked like before your surgery and without actually examining you.

Gary M. Horndeski, MD
Texas Plastic Surgeon
4.6 out of 5 stars 230 reviews

Is this capsular contracture? If so, what Baker grade? How long to take Singulair?

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Hello! Thank you for your question! Physical examination will determine if you have capsular contracture. The look and feel of hardness surrounding your implant is seen and/or felt. At its worst, you experience pain. It may also cause distortion of your breast. What has caused it will be in question.  Given your description, it sounds consistent with capsular contracture - but only an examination could determine. Grade is a physical examination necessity. 

Your surgeon will likely recommend implant massage and may add the medication Singulair. If these fail, surgical correction may be suggested. It is a matter of surgeon preference as well as what is seen during your procedure that will determine whether or not a complete capsulectomy is performed. If significant capsule formation is seen intraoperatively, a full capule removal may be warranted with a drain in order to completely remove all of the tissue and allow better adherence of your breast back to its normal anatomic position down on your chest wall. Irrigating with certain medications may also be if benefit. If minimal contracture is seen, it may be possible to leave the capsule, or place cuts within the capsule to allow better adherence. It truly is dependent on what is seen with your capsule and the issues that may be causing you to have such a procedure (e.g., contracture from rutptured implant vs pain vs simple pocket adjustment, etc).

Without knowing your issues and without an examination, it is difficult to tell you what may be the best thing for you. I tend to favor performing capsulectomies in order to create a fresh pocket, reshape the pocket, allow better shape and adherence of the overlying breast. I would discuss your issues with your plastic surgeon who will assist you in determining the right modality for you.  Cost will vary with geographic area and would expect similar pricing your initial procedure, but discuss with your surgeon.  Hope that this helps! Best wishes!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 28 reviews

Use of Singulair for treatment of Capsular contracture

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There is no proven data that supports use of Singulair for treatment of capsular contracture.  Although there may be risk factors (hematoma, infection) that contibute to capsular contracture, we do not yet know why some people develop capsular contracture and others don't.  Given your post-operative photos, you probably have capsular contracture as long as you had started with symmetric breasts to begin with.  Without examining you, it is hard to tell what degree of capsular contracture you have.  Do you have pain? Is it firm?  I would recommend implant exchange, capsulectomy, and lowering of the IMC on the right side rather than trying Singulair.  Good luck to you.

Capsular contracture can deform breast implants

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Your pictures shows two different breasts.  Both look good but tey do not look symmetric.  This could be because you started out with two different breasts, because during surgery the space into which your implants were placed were different, or because after surgery the two breasts healed differently with the right contracting more.  Based on your one picture it is difficult to determine which one of the possible scenarios applies to you.  If you had good symmetry right after surgery and now your breasts are significantly different then you may have capsular contracture.  At this stage Singulaire would probably not work and you may need a capsule release.
You should talk to your plastic surgeon.  Make sure your surgeon is a board certified Plastic and Reconstructive Surgeon.
The cost of revision depends from clinic to clinic.  Some surgeons may charge you some small fee, some may do touch ups free of charge.
Martin Jugenburg, MD

Martin Jugenburg, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 518 reviews

Singulair for CC

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Singulair is used as a FDA off label usage to treat Capsular Contracture and in some cases of recurrence of capsular contracture in a preventative fashion. This does not apply to you for the following reason: Although capsular contractures following breast augmentation can occur just about anytime, most women start having symptoms around three months after their breast implant surgery. This is because it takes some time for a capsule to form and then to scar down (contracture). Therefore it is probably too early at 3 weeks to be concerned about this problem. Your signs and symptoms are most likely from muscle spasm although other factors could also cause this. Your plastic surgeon should be able to sort this our in short order.

Capsular Contracture and Singular

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hello!--I have used Singular in the past with mixed results--It has helped some but only after 3-6 months and very mildly. Removal with capsulectomy and placement of implant does a great job. If it comes back, the other option I have used is removal of implants , removal of capsule  and allow the breasts to "sit" for 6 months without a foreign body.  This allows the body to reset itself . That would be for RECURRENT Capsules

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.