Capsular Contracture, Leaking Fluid 11 Months After Breast Augmentation - Normal? Cost?

Capsular contracture comes in several grades.  If the capsule is firm and changes the shape of the breast then surgical intervention is usually necessary.  If pain is an additional component then surgery is definitely warranted.  Regarding the nipple discharge, if the discharge is clear-yellow then this may represent a seroma. Seroma can be detected clinically or with ultrasound.  11 months after the procedure a seroma should be treated before it becomes an infected seroma.    If the discharge is thick and yellow then this may represent a low grade infection of the nipple and ducts of the breast.  This needs to be treated differently usually with antibiotics. Regarding insurance coverage for revision of a cosmetic procedure, insurance companies usually will not cover these procedures.

Dr. ES

When someone has capsular contracture and possibly fluid build up around the implant, it can lead to some nipple discharge.  Sometimes it is simply from the increased pressure on the nipple area.  Other times it is the actual fluid being pushed out.  Either way, while possible, it is not very common.   To say otherwise is misleading.   For most women, if they get to the point where they are seeing a difference in the shape of the breast, then massage and/or Singulair will not have much effect.  You probably need to have a revision where the scar tissue is removed, and possibly change to a different implant, different pocket, etc.  Insurance covergae is spotty since it is a cosmetic surgery, but it doesn't hurt to check.  I hope this helps.

Without photos or preferably a face to face examination and details of the surgery no surgeon can give you detailed specific answers to your case. We do not know what type of implants you have (silicone or saline) or their position or the severity of the contracture. You describe 2 problems the capsular contracture and the yellow fluid coming out of the nipple.

The vast majority of breast augmentation patients have some degree of capsular contracture. It is only the more severe degrees with symptoms whose treatment would be covered by health insurance in which they only pay for capsule removal and they do not pay much. The less severe degrees of contracture are not associated with symptoms and only detract from the appearance. Their correction is cosmetic and not covered. 11 months is a little early to have revision surgery and may start you down a path of repeat surgeries because each surgery including capsule removal to some degree stimulates the scar formation response. Only get additional surgery if you really need it.

The fluid leaking is a separate issue but may have been caused by the same thing that caused the contracture. It could be a late seroma that occurs distant in time after the initial surgery. This is more common with textured implants (friction irritation) or with some trauma to the chest some point in time after surgery. The best way to noninvasively prove the existence of a seroma is ultrasound or MRI. If a seroma is detected it will need to be drained and the implant may have to be removed at least temporarily along with the capsule.

You have alot of questions and they are difficult to answer over the internet. Occasionally patients with implants can develop galactorrhea and that may be one explanation for the drainage. However, it is not likely that drainage is the sign of a seroma.

So sorry to hear about this outcome.  Capsular contracture is one of the most dreaded and frequent complications of implants.  Even the manufacturer quotes a capsular contracture rate of 10%.  There is some evidence that Singulair may assist in resolving this problem, but it is far from a guaranteed cure.  Many women must return to surgery for a capsulectomy.  It is ideal to seek surgery only as a last resort.  It may be prudent to continue vigorous massage and Singulair for several weeks before considering further treatment.  There are health plans that will cover the surgical costs associates with a capsulectomy.  It simply depends on the plan.  Make sure to seek pre approval before undergoing surgery so you don't become responsible for an unexpected bill.  Clear yellow fluid may exude from the nipple both with and without implants.  Over the long term, this is not likely to remain an issue.  Good luck!

It is possible that you've developed capsular contracture. Considering that it's a complication, it may be covered by insurance in Canada. However, the replacement implant may not unless it is outlined in your warranty.If you've lost faith in your surgeon, find another one you can trust.

Everyone's health insurance policy is different, however, in general, most health insurance plans do not cover any complications resulting from a cosmetic procedure. You have to read the fine print of your individual plan. It doesn't hurt to try and bill health insurance since they do cover these issues sometimes. However, there are very reasonable priced cosmetic insurance plans that can be purchased prior to your cosmetic procedure that cover complications resulting from the cosmetic procedure. Your plastic surgeon can give you information on these plans that are sold by a separate company. You can also ask your plastic surgeon if you are at increased risk of having a complication and thus worth the extra expense of obtaining the policy. Best wishes,Pablo Prichard, MD

Having fluid draining from your breast 11 months after a breast augentation is not normal regardless of haviing a capsular contracture. I would speak to yoru surgeon or find another doctor.

Unfortunately, capsular contracture can occur in up to 10-15% of patients who undergo a breast augmentation. This is difficult to predict in patients, and it is not fully understood as to why this happens in the first place. The treatment has routinely been the removal of the capsule, reshaping the pocket, placing a new implant and recently the use of artificial "dermis" has been used to reduce the ability of the capsule (which is normal) to contract. Using medications "off label" such as Singulair have been employed with varying success.

Complications relating to cosmetic surgery is not usually covered by most insurance companies unless your doctor has signed you up for a specific cosmetic surgery insurance program. The drainage from the nipple is also somewhat concerning as seromas are usually contained within the breast pocket and do not connect to the breast ductal system. I would suggest visiting with your doctor again to see what you can work out, or looking at getting a second opinion. No amount of massage will treat a contracture once formed.

Best of luck!

Regarding: "Capsular Contracture, Leaking Fluid 11 Months After Breast Augmentation - Normal? Cost?
From my review: I recently noticed yellow fluid would come out of my right nipple. I later found out that I have Capsular contraction on my right breast. I got my breast argumentation done 11 months ago and the doctor said I need to massage more on the right breast and take some Singular. He also informed me that it is normal to have fluid to leak from the breast and I don’t think he is right at all. Any suggestion??? I been researching and I think I might have Seroma? And I would like to know what I need to do to get rid of capsular contraction and if any health insurance would actually cover it. My husband is in the military so I read somewhere that the surgery was free for another patient that also had capsular contraction. Is this true?"

Sorry to hear of your predicament.

It sounds as if you had a capsular contracture (severe scarring around the breast implant) for a while since your surgeon "said I need to massage more on the right breast and take some Singular" BEFORE the onset of the nipple drainage.

Capsular Contracture may be seen in 15% of breast augmentation cases and although it is associated with infection, blood or foreign bodies in the breast pocket, the vast number of cases are without an explicable cause. The use of asthma drugs (Singulair, Accolate) etc has NOT been proven to be effective and there have been a few cases of liver damage associated with their use mandating extreme caution for this off-label use. Vitamin E and other oral supplements have been used without predictable success.

The ONLY way to get rid of the scarring is remove it surgically (CAPSULECTOMY), an operation which is more involved and expensive than the original Breast Augmentation. Unfortunately, the likelihood of scar recurrence is high. There appears to be a great drop in capsular scar contracture IF the scar removal is combined with placement of a pig skin matrix (ADM such as Strattice). Unfortunately, these sheets are expensive.

NO INSURANCE that I am familiar with will pay for these corrective operations. In rare cases, they MAY pay for breast implant removal. You need to consult with your Plastic surgeon and find out YOUR options.

Good Luck.

Dr. Peter Aldea