5 months post op and despite aggressive breast displacement massage and Accolate for 3 mos Rt breast still higher than Lt (feels like it is stuck in its current position) although movable and soft. Medial border of Rt breast is well defined (obvious appearance of the silicone) vs the Lt which look more naturally "dropped". Will Rt breast capsulotomy solve this dilemma or will you do something different? I'm not too happy on going back under the knife too soon :-(
Will Capsulotomy Solve This Problem? (photo)
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Doctor Answers 9
Why was one breast so large during your recovery? If you had a potential hematoma, its likely a capsule procedure may be needed to improve your symmetry. If you breasts are soft and mildly asymmetric, it may be better to simply leave it alone and revise when something else happens that requires a trip back to the operating room.
Fixing the right side
Although it looks like the right side has definitely improved over time, it still looks a little high. It might well need a re-exploration - with either a capsulotomy or lower pole capsulectomy, depending on what the surgeon finds intra-operatively. Both techniques can be useful. That side also looks a little smaller - maybe an implant size change or fat grafting could also be considered.
Will Capsulotomy Solve This Problem?
In the absence of capsular contracture, capsulotomy is appropriate if the pocket is small. Find a plastic surgeon with ELITE credentials who performs hundreds of breast augmentations and breast augmentation revisions each year. Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results.
Kenneth Hughes, MD Los Angeles, CA
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Breast issue and tightness
It is always helpful to see pre-op photos to ascertain asymmetries. If you have a capsule on one side then a revision may be necessary.
Will Capsulotomy Solve This Problem? (photo)
I wonder if you had asymmetry from the before appearances. Yes I think a larger implant plus a capsulotomy would improve. I might also recommend fat gratfs.
Unilateral capsular contracture, causes and treatment
One of the oddities of breast augmentation is a unilateral capsular contracture. If this was a reaction to the implant it would have done it on both sides. The possible causes of your problem include surface contamination of the implant including. This can occur from lint from the drapes, powder from the gloves, oil from the skin or contamination from surface bacteria on the skin. For an established capsular contracture the best treatment is usually a capsulectomy, total removal of the capsule, replacement of the implant using the no touch technique or a Keller funnel.
You have certainly waited long enough and I don't think that the right implant will drop anymore. You will need a revision on the right breast which would involve removing some of the capsule in the inferior portion of the breast. The good news is that this surgery should correct the problem. You may also have some sternal asymmetry but it is hard to tell without an exam. Many of the post op deformities are caused by pre existing conditions which are sometimes hard to appreciate prior to surgery.
Will Capsulotomy Solve This Problem after Breast Augmentation?
Thank you for the question and pictures. The breast implant “displacement” and breast asymmetry that you are referring to is clearly visible in the photographs you post. I think that revisionary him him him surgery will likely be helpful. This operation should be done very carefully; one of the potential problems that may arise with over dissection and/or removal of breast implant capsule is further problems with breast implant displacement and/or significant rippling/palpability of the breast implants.
Make sure that your plastic surgeon is well experienced with revisionary breast surgery.
Hi LilacLuv, as you probably know by now the management of capsular contracture is very unpredictable. Following the sequence of your photos it looks like the malposition of the right implant was obvious and more severe earlier so now at 5 months it is much better but still noticeable. To me that indicates that the earlier deformity could be due to technical difficulties at the time of the original surgery so it is my opinion that you have a pretty good chance of correcting it with revision surgery. The prognosis would be totally diferent if your results were perfect at first but then capsular contracture set in later producing a obvious deformity. I don't have a good explanation for why this happens, I've just observed it on my patients. Early malposition generally responds very well to reoperations with capsular releases... DrBrou
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