3 weeks post, my left breast was not healing the same as the left. Is it capsular contracture? (photo)

got my BA on April,3rd.  It was really hard and the implant was not really mobile. At my one month check up my Dr told me it was CC so prescribed me singulair and recommended intense massaging. its been 2 weeks since Ive been taking it and it doesnt really seem like its working much. Im afraid Ill need another surgery?

Doctor Answers 7

Capsular Contracture

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I am sorry that you are experiencing this difficult and common problem. Just a few words about capsular contracture in general:

Capsular contracture is still not completely understood, but it involves an individual's genetic predisposition to inflammation, caused by a number of triggers at the time of or after the surgery: excessive bleeding , excessive tissue trauma, and/or bacterial contamination of the implants ('biofilm'). Implant message after surgery will not prevent it, nor will it treat it once it has become apparent. There are no known non-surgical ways of treating capsular contracture reliably or consistantly once it has happened, but some techniques that have been looked at include antibiotics, high dose vitamin E, Singulair/Accolate, and external ultrasound. The most reliable way of treating capsular contracture and minimizing recurrence is by surgical removal of the entire capsule and implant in a way that there is no re-contamination of the surgical site with bacteria, and a new implant is replaced.

In my practice, I am very concerned about symmetry after a total capsulectomy, and I frequently recommend adjusting the other side if necessary, because it is common for the treated side to become lower than the non-treated side.  I also never reuse an implant; you cannot resterilize it. The potential that it has biofilm on it's surface is very high, and reusing it makes recurrence much more likely.

My philosophy and techniques to treat capsular contracture do not always prevent recurrence, nor do I always get perfect symmetry afterwards either. However, data suggests that this is the best practice. It is also the most expensive technique too, and many patients would opt for less (one sided surgery/re-use implant). I no longer perform anything less, as it increases the risk of recurrence and therefore is more expensive in the end.

Both the surgeon and the patient put very high hopes in massage and Singulair, as it avoids surgery and is relatively inexpensive.  Unfortunately, the rate of resolution of capsular contracture with this method is about the same as spontanteous resolution after no treatment at all, about 10 to 20% of the time.

You should harden yourself to the fact that another surgery is going to be required, unfortunately.  Looking at your photograph, it is also clear that your implants are too large for your body anatomy, increasing your risk for capsular contracture and recurrent capsular contracture.  You should consider downsizing your implants as well to maximize the potential for a successful  surgical revision.  Revision surgery is much more difficult than primary breast augmentation, and you should be sure that your surgeon is qualified (certified by the ABPS, member of ASAPS) and experienced (great reputation for revision surgery).

Best of luck.

Beverly Hills Plastic Surgeon
4.9 out of 5 stars 100 reviews

Asymmetry after augment; capsular contracture?

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Your photo definitely shows a difference between your breasts and I would not be surprised if the difference was more noticeable in person. At three weeks (now five) you are still quite swollen and it is not unusual to have one side that is more swollen than the other. There may also be some fluid that has collected on your left that would make it appear different and firmer. Although you may need surgery in the future, it is much too early to consider. Give your breasts a chance to settle down and see how they do over the next few months. And keep your follow up appointments with your surgeon who is in the best position to evaluate your healing. Good luck.

Margaret Skiles, MD (retired)
Sacramento Plastic Surgeon

Capsular contracture?

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Based on your photos, your implants appear to be high riding.  This could be due to swelling as you are only 4 weeks after your procedure.  However, it may be capsular contracture as well.  I recommend you follow up with your plastic surgeon closely.  I would ancitipate that you will need a corrective procedure in the near future.  Best of luck. Dr. Basu

Capsular Contracture After Breast Augmentation

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Capsular contracture is one of the most challenging aspects of breast augmentation surgery. From your photos, you do appear to be high on both sides for 1 month after surgery with the left side being more so than the right. Singulair is worth a try, but it is possible that you may need another procedure to correct this. Stay in touch with your surgeon, as this will be very helpful to you in making decision in the future. 

Best of luck!

Vincent P. Marin, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 52 reviews

3 weeks post, my left breast was not healing the same as the left. Is it capsular contracture

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Thank you for submitting your question and photo. Your very early in your recovery from breast surgery. Your breasts will change over the next several months.  Implants do not drop at the same rate.  Final results take 6-9 months.  If there is a noticeable size difference after 9 months then a revision may be needed.  Discuss your concerns with your surgeon . Best wishes.

Early capsular contracture

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Early treatment and intense massage may help the condition.  If you develop early signs of capsular contracture, I would begin treatment early and consider breast revision surgery. 

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
4.8 out of 5 stars 95 reviews

Misshapen breast after breast implant and capsular contracture

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Your left implant definitely sits higher than your right but more/as important the contours are squared off along the inner and outer sides of the breast, left more than right. This can be due to an inadequate pocket dissection, seroma fluid or hematoma around the implant, capsular contracture and/or implants whose base diameter is too large for your chest.

Sometimes wearing velcro straps right after surgery can reposition a breast implant but that cannot correct for capsular contracture or an implant that is too large for your chest and works best if started right after surgery. I suspect you will need revision surgery but you need to give the tissue sufficient time to recover from the first operation to know what if anything needs to be done and avoid further problems from reoperating too soon.

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

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.