Capsular contracture concern 14 months post op (Photo)

Question

Does this look like capsular contracture? The implant is still soft but I can't help to notice the difference. Thank you for any feedback.

Jed H. Horowitz, MD, FACS · Answer

dear diligient
CAPSULAR CONTRACTURE concerns after 14 months
This is a condition where the capsule around the implant thickens and squeezes the implant making it have a Feeling of tightness or pulling Discomfort a Distorted look to the breast (hard and often changing the shape and position of the implant. 
In your case there is likely some flattening that shows in the one photo.
 It is more common in nicotine users (e.g. smoking or nicotine patches or gum). Effective treatment of the capsule frequently involves completely removal of the capsule (capsulectomy), and occasional incisions in the capsule may be somewhat helpful (capsulotomy). In the past, closed capsulotomy, in which the breast is squeezed until the capsule breaks, was used. Currently, most doctors avoid this technique because of complications associated with the technique and because the implant companies will void their warranty if this technique is used. At times it is necessary to change the position of the implant, either above or below the muscle, depending upon the initial position, changing the implants themselves and, on occasion, the use of Acellular Dermal Matrix (ADM) may be required to prevent continued problems. Although the published risk of capsular contracture is approximately 9-11%, in our practice it is somewhat lower after initial implant placement. Once capsular contracture occurs, the risk of problems with secondary surgery rises to between 25% and 40%. The use of Singulair and Vitamin E may be of benefit. If you had a Sientra Textured Implant placed as a primary procedure and a contracture occurs in the first two years after primary augmentation, then their implant warranty may apply.
Candidates for Surgery
Women with existing breast implants experiencing complications such as:

Hardening of the breast implants (due to pressure from a capsular contracture)Feeling of tightness or pullingDiscomfortDistorted look to the breast (an unnatural round appearance or assymetry)Rupture or Deflation of an implantRippling or Wrinkling
Capsular Contraction: The scar tissue that forms around the implant is a natural response to a foreign object implanted in the body. The capsule can tighten and squeeze the implant making it firm. This is referred to as capsular contracture. This firmness (breast capsule) can range from slight to very hard. The firmest ones can cause varying degrees of discomfort or pain. Capsular contracture can occur in one breast or both
Its best to go back to your doctor and perhaps get an ultrasound

Dallas Buchanan, MD · Answer

This is a poor photo to be able to answer this question and honestly it cannot really be answered from a photo anyway. At 14 months, is this likely to be cap con? No. Unless your implants at one point settled into the perfect position and then recently have begun to change. This early it is more likely a result of differences in initial pocket creation or healing to where the implants never quite settled into an ideal position over time, correct?
Hope this helps!
Dallas Buchanan, MD
VIVIFY plastic surgery
Tampa, FL

Darryl J. Blinski, MD · Answer

The one posted photo is a really limited help. It’s too close. Best of virtual consult with. It appears there’s minimal difference in the appearance of the breast from the one posted photo if you feel a capsule, contracture firmness, hardness, or malformation then best to see your operative surgeon or try a virtual consult with. Revision fees range from $5000-$10,000

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