Capsular Contracture at 3 Weeks Post-Op - PS Recommends I Lift Weights

Question

I'M ONLY 4 WKS POSTOP w/CC. If possible, I would rate this CC a 6-7 on the Baker Scale. Extremely painful, but always figured from being placed under the muscle, also had a lift.  For the past 4 wks I've told my PS the right was diff-very swollen/more painful. As always he says "give it time, it'll be fine. Now he wants me to start lifting weights...adding more pain! He's not really concerned with massaging. Another concern, lymph nodes in armpits are nearly 1" big. Can this be related to CC?  Do I need further surgery?

Richard J. Bruneteau, MD · Answer

It’s unusual
for patients to develop capsular contractures within four weeks of breast
augmentation surgery.Capsule formation
of this magnitude could only occur in response to significant inflammation.Both bleeding with hematoma formation and low
grade infection could be capable of generating this type of response.Although it’s virtually impossible
to make a definitive diagnosis without a physical examination, both of these
conditions should be ruled out.Your
severe pain, swelling, and enlarged lymph nodes suggest that this type of event
may have occurred.Under these circumstances, I
definitely wouldn’t start lifting weights.It’s important that you be reevaluated by your surgeon, and if you’re
not satisfied by his response, it’s appropriate to get a second opinion.It’s not only important to treat your
capsular contracture, but also to treat what may have caused the
condition.

Jonathan Saunders, MD · Answer

do not weight lift. yes you may or will need revision in the future. keep in mind that the revision rate after augmentation mastopexy is 30-40% in most series. i would stay with your surgeon if you have a good relationship. too early to abandon ship. yes infection is also a concern. i would be seeing you weekly if not twice a week. do not know where you got the capsular contracture number

Martin Jugenburg, MD · Answer

Looking at your pictures, and considering the history that you described I would recommend getting a second opinion.  Make sure your second opinion is a board certified Plastic Surgeon.  Was your initial surgeon a board certified Plastic Surgeon?

	Sincerely,

	Martin Jugenburg, MD

Richard H. Tholen, MD, FACS · Answer

But at least it gives you something to do while time goes by. Revision should not even be considered for at least two more months, and if things are still changing, many of us would recommend waiting at least 6 months for surgical revision.

	Of greater concern is that this swelling and pain may be related to bleeding (now stopped, of course, but the "old blood" is still in the pocket and can be a cause of capsular contracture), or infection. While the latter is less likely than bleeding, it is more serious, and either of these concerns can require re-operation.

	Axillary lymphadenopathy can be due just to the inflammation and healing related to surgery, but can also be secondary to these other causes. Capsular contracture does not in itself cause swollen lymph nodes, but both bleeding and bacterial contamination (or infection) can cause swollen lymph nodes as well as increase the risk of developing capsular contracture.

	That is why it is important to return to your surgeon for recheck now, not at you next routine appointment. good luck!

Paul Gill, MD · Answer

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

Peter E. Johnson, MD · Answer

Capsular contracture is uncommon after four weeks and my best suggestion is to consider the cause, perhaps the pocket, bleeding. If the breast is indeed sore or swollen, and lymph nodes are enlarged suggesting inflammation, the weight lifting idea does not sound like a good plan of action. You may have to have a second opinion locally to make certain that all is well with your breast, especially with a grade 6-7 capsule on a 4 point scale.

	Best of luck,

	peterejohnsonmd

Steven Schuster, MD, FACS · Answer

It certainly is possible to have a CC after 4 weeks but it is unusual. Enlarged lymph nodes are not uncommon and may not indicate an infection, only recent surgery. If the breast is warm and swollen then I would see your doctor as soon as possible. From your pictures it appears the nipples are at different heights as are the implants. Provided there is no infection I would probably wait2-3 months and at that time do a revision. I agree that I don't think lifting weights will be of any benefit in this problem. Good Luck, Dr. Schuster from Boca Raton.

Steven Wallach, MD · Answer

It is hard to say without an exam. It is not common to have enlarged axillary lymph nodes 4 weeks after surgery. It could be possible that you have a low grade infection. You should follow closely with your doctor. I do not know how weight lifting will help you.

Marcel Daniels, MD · Answer

Pain and swelling are not the typical presentation of early capsular contracture but of more concern is the possibility of a low grade infection. I am unsure of the role of early weight lifting in the management of capsular contracture but go back to your surgeon and share your concerns. If your surgeon is insensitive to your needs a second or third opinion may be in order. When getting second opinions always bring a copy of your medical records as it helps the second opinion surgeon understand better what went on during your surgery.

George Commons, MD (retired) · Answer

Yes, you appear to have a capsule contracture and likely will need a second surgery to lower the right and release. This can happen at 4 weeks but with the pain and nodes etc you need to get back to your doctor and share your concern. If your doctor is not responsive get a second opinion from an ABPS-FACS surgeon. If you go for a second opinion get full records from your doctor including pictures, notes, and op notes. Lifting weight is unlikely to do much but I suppose it could help? Sometime the Veronique Breast Band for a month helps but not always. It is worth a try. Did you take Singulair. There is evidence in the UCLA study that this definitely helps prevent and soften capsules. Singulair, 10 mg daily for 14 weeks. Do it. Take 400 iu of vit E daily. Use the breast band with soft added padding on the right to help push the right down. This I have seen work over my 30 years of practice. Like nudging a huge boat off the shore. Scar tissue expands with gentle pressure. Do not do any surgery for 4 months. The above will give you things to do that may help in the meantime. Good luck. Dr G Commons

Capsular Contracture at 3 Weeks Post-Op - PS Recommends I Lift Weights

Answers (10)