Do I Have Capsular Contracture or is It Still a Muscle Spasm?

Question

I'm two months post op. My implants still sit high, and feel hard. They also look like they have a hump from a profile view, which worries me. My implants are not moving down into their pockets at all! I've been doing massages to move the implant and reduce scar tissue from forming and started taking vitamine E. My PS says its muscle spasm which is causing my implants to stay high on my chest, but could it be capsular contracture? From small A to small D, submuscular, 460cc, silicone

Richard H. Tholen, MD, FACS · Answer

With due respect to my colleagues and your own plastic surgeon, spasms are usually intermittent and uncommon 2 months post-op. Though capsular contracture is unusual this early after surgery, I have seen it on a few occasions, and have thus been "forced" to accept early capsular contracture as reality.

	High, tight, and "hard" sounds like capsular contracture to me, even if unusually early. Did you have significant bruising/bleeding in your early post-op period? Did your surgeon by any chance use drains? if so, how long were they in? Did you have dental work shortly after your surgery, exposing your not-yet-healed breast capsules to bacteremia? All of these are things to consider as possible causes/contributors of capsular contracture. 

	However, it is still too early to consider re-operation regardless of the cause, and Vitamin E is not all I would recommend at this point. I would use an elastic bandeau at night and go braless during the day to help your implants to drop (if possible), while also adding vigorous downward implant movement exercises. I would also consider daily oral Singulair (a leukotriene inhibitor usually prescribed for asthma, but helpful in as many as half of evolving capsular contracture patients) in addition to  twice-daily 400 iU of Vitamin E orally. Ultrasonic treatments may also help to slow progression or improve early capsular contracture.

	If all else fails by 6 months, then re-operation is likely the next step. Best wishes! Dr. Tholen

Jeffrey J. Roth, MD, FACS · Answer

Thank you for your question.  Hard to say much without photos or exam.  Breast implants tend to start dropping into place after 3 to 4 weeks. They usually will get to their final position in 6 to 12 months. One will usually drop faster than the other, and the shape may go through changes.  Please follow your Board Certified Plastic Surgeon's post op instructions. For example; we like message, but some surgeons will have you wait, or do it in a specific manner. Please let them know your thoughts and concerns. Jeffrey J. Roth, M.D., F.A.C.S.Board Certified Plastic SurgeonLas Vegas Plastic Surgery

Vincent N. Zubowicz, MD · Answer

It is very unlikely that firm breasts at 2 months are from capsular contracture. The capsule is definitely forming but the cells that cause contracture would not be established enough to create the problem.

Robert Brueck, MD · Answer

This could be capsule and I would wear a velcro bra strap over the top of your breast to try and get them to settle down more.

Steven Wallach, MD · Answer

At two months it is a bit early for a capsule to develop. You should give it 3-4 months at a minimum for the implants to settle.

Do I Have Capsular Contracture or is It Still a Muscle Spasm?

Answers (6)