Capsular contracture? (photos)

I'm 7 weeks post op and my left breast has not dropped as it should , when I massage it the implant feels very different from my right. My ps said to keep doing my excersise but never once has done a physical exam. I'm worried he's being very dismissive instead of taking my concern seriously . How can I tell If I do have a capsular contracture ?

Doctor Answers 17

Capsular Contracture

Thank you for your question and photographs.

Remember, you are still in the early post operative period and breast massage is critical. Vitamin E 1000IU taken twice a day is very beneficial to help prevent capsular contractures. If you have any concerns, please consult your plastic surgeon and ask him to perform a physical examination to determine whether or not you have a capsular contracture. On the photograph with both of your arms down, it appears to me that your are healing normally, however, I think it is essential you see your plastic surgeon and address your concerns.
Good luck in your recovery!

James Fernau, MD, FACS
Board Certified ENT
Board Certified Plastic Surgeon
Member of ASPS, ASAPS, ISAPS, The Rhinoplasty Society, AAFPRS, OTO/HNS, ASLMS

Pittsburgh Plastic Surgeon
4.9 out of 5 stars 64 reviews

Capsular contracture

Capsular Contracture is a condition in which the capsule surrounding the implant thickens and contracts, squeezing the implant making it overly firm or hard and often changing the shape and position of the implant. As the capsule contracts it moves the implant further up your chest wall making upper portion of your breast too large and unshapely. It is more far more common in nicotine users (e.g. smoking, vaping or nicotine gum or patches).

#breastaugmentation #plasticsurgery

Dear Littlemssunshine, Congratulations on your recent surgery and thank you for your excellent question.  Here at CARE we actually see all of our breast augmentation surgery patients the very next day after surgery and then again at two weeks and beyond. We enjoy staying closely connected to our patients and enjoy giving the extra attention and service.Your concerns are important to discuss directly with your board certified plastic surgeon. He or she will appreciate the open communication and will want to help you. If you decide to seek a second opinion, look for are the following:  *Board Certified by the American Board of Plastic Surgery -- The gold star symbol *A member of the ASPS (American Society of Plastic Surgeons) -- The circle symbol  *A member of the ASAPS (American Society of Aesthetic Plastic Surgeons) -- the Queen Nefertitti symbol with a Triangle.  Feel free to contact our office, it would be our pleasure to answer your questions in person.  My very best, Brian S. Coan, MD, FACS

Brian Coan, MD, FACS
Raleigh-Durham Plastic Surgeon
4.9 out of 5 stars 49 reviews

Capsular Contracture

Thank you for your question! You do want to keep doing your exercises to help with movement of your implants, this too can help if you have a contracture forming. You can tell you have a hard capsule by the feel of your breasts. They should both be soft and both move within your implant pocket. If your left breast is harder than your right breast I would call your surgeon and have them take a look at it. Sometimes it does take one implant a little longer to drop than the other. Try doing twice the amount of exercises on your left breast than you are your right and see if this helps. Good luck!

Ed Breazeale, Jr., MD
Knoxville Plastic Surgeon
4.9 out of 5 stars 8 reviews

Possible Capsular Contracture, but too early

Thank you for your question!

In general, capsular contracture (CC) can occur at any time, but most cases are documented in under 12 months (i.e., anywhere from 3 months to 12 months post operation). This is because it takes time for the fibrous tissue capsule to form around the implant, and then it will have to scar down (contract).

Nevertheless, CC can start early when there is significant bleeding or infection or another co-existing problem.

Usually, the breasts will feel firm and tight this early after breast augmentation, making you feel that it may be capsular contracture. However, such tightness is just because the breast tissue and skin have not adopted to the implants yet. With effects of gravity and healing, the breasts will feel more natural and soft as time goes. Once that happens, the implant will sit directly behind the breast tissue in a natural 45:55 breast ratio. Your breasts will achieve final results after 3 to 6 months post-surgery.

It is also not uncommon for breasts to heal and adapt to implants at different rates.

Now I need you to know that there are 4 grades/levels of capsular contracture:
  1. Grade I — the breast is normally soft and appears natural in size and shape.
  2. Grade II — the breast is a little firm, but appears normal.
  3. Grade III — the breast is firm and appears abnormal.
  4. Grade IV — the breast is hard, painful to the touch, and appears abnormal.

If your breasts do not appear abnormal, tight, firm, or painful, then you are fine and shouldn’t not be concerned, especially because it has only been 7 weeks.

Now, grades 1 and 2 CC do not require surgery, and can be fixed with breast massaging and singulair.

Massaging will keep the naturally occurring capsule stretched hindering it from contracting. However, this should not be done excessively as you may further aggravate the breast pocket causing inflammation.

That being said, you can also help prevent a capsular contracture by having regular follow-ups with your surgeon to make sure your breasts are healing beautifully.

Good and transparent communication with your surgeon is important. Discuss your concerns with your surgeon honestly without getting angry, and share your expectations of care, and let them know that you do not intend to be a difficult patient but are following-up to get a physical exam as the left breast feels ‘very different’ than the other one.
Don't be discouraged.Hope this helps.

Martin Jugenburg, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 414 reviews

Capsular contracture?

Thank you. Capsular contracture takes at least 6 months to form so It is unlikely at 7 weeks. It takes about 3 months for the implant to settle completely, that is for swelling to totally resolve and the muscle to relax so you can get one side slightly different to the other during the healing period. Please get your PS to check on you again, All the best.

Sydney Plastic Surgeon
5.0 out of 5 stars 118 reviews

Capsular contracture and breast augmentation

Thanks for the question and for the photos.
A capsular contracture takes much longer than 7 weeks to form.  It appears that the left breast implant is still sitting high.  This is not uncommon when placed under the muscle.  Massaging, sometimes using an ace bandage above the level of teh nipples aids in having the implant fall into the pocket.  IF after 6 months they are still asymmetrical, a revision might be in order.
Best of luck.
Dr. T

Douglas Taranow, DO, FACOS
New York Plastic Surgeon
4.8 out of 5 stars 48 reviews

Capsule contracture?

Hello misssunshine. It would be very rare to have a capsule contracture at 7 weeks and asymmetry at this point is a fairly normal finding that tends to improve over time. Your plastic surgeon should re-examine your breasts next time to diagnose CC. Perhaps, concentrating on more breast massaging and discussing different massage techniques and even adding a muscle relaxant are other topics you can considering talking to your PS office staff while you wait for your next appointment. Best. Dr. ALDO

Aldo Guerra, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 185 reviews

Capsular contracture?

Thank you for your question and photos.  It is probably too soon to discuss asymmetry - all looks fine so far.  Best to follow-up for an in person examination with your plastic surgeon to discuss your concerns and evaluate.  Best of luck.

Breast implant sitting high

Thank you for asking about your breast augmentation.
  • Your implant is sitting high - 
  • This happens when implants are put under the muscle.
  • The muscle has to relax to let the implant settle in place.
  • Capsular contractures take time to form - usually six monthsn at least.
  • If your implant does not settle, you will need the capsule released to move the implant into place.
  • Ask your surgeon if you can go bra-less....without a bra, some implants settle because gravity pulls them down.

Always see a Board Certified Plastic Surgeon. Best wishes  - Elizabeth Morgan MD PHD FACS

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.