I Am Becoming Very Concerned About Capsular Contracture. What Do You Think? (photo)

I am 46, 5'4", 118-123. Both 400cc-silicone gel-high profile-unders. Good size for me. From the get go I was high and tight as I had dense peck muscle tissue. I am now 10 months post op and my implants are still high and tight--especially the right. Am I developing capsular contracture? They have not and do not move about freely. I can barely squeeze them together and are hardish when laying on chest. Tips on softening them? Will strapping or laying on them help? Do you think I need surgery?

Doctor Answers 22

This appears to be capsular contracture.

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Comparing your 3-month post-op and your 10-month post-op photos shows progression of capsular contracture. This is particularly evident in the last view with hand pressure causing the severe and "sharp" edge visibility. Especially with below the muscle implants, your breasts should be much softer and gradual in appearance, more like your first 2 photos at 3 months. Are you sure your surgeon went below the muscle? Submammary implants are somewhat more likely to develop capsular contracture because of bacterial contamination of the pocket and biofilm formation which stimulates capsular thickening and contracture. However, this can occur even with below the muscle implants.

Other than a 3 month trial of Accolate or Singulair plus oral Vitamin E (which MAY work to soften capsules in up to half of patients), there is no solution for this problem other than surgery. Pressure by laying on them or using an elastic strap is of no value at this point in time. External ultrasound, infrared, and massage therapy are also of questionable and limited value, so you should see your plastic surgeon (or several ABPS-certified plastic surgeons) for physical examination of your breasts and recommendation for the appropriate surgical intervention. Best wishes!

Minneapolis Plastic Surgeon
4.9 out of 5 stars 263 reviews

Not likely a capsular contracture

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There are many suspected causes of a capsular contracture but the most likely causes are implant contamination, bleeding and infection. Surgical technique is critical as prevention is the cure for capsular contracture. The risk of a capsular contracture when implants are placed above the muscle is in the 20 to 30% range. When the implant is placed either subfascial or sub muscular the risk is in the 4 to 7% range. The no touch technique was first described in 1991. This means avoiding any surface contamination of the implant during insertion. The no touch technique combined with irrigation with antibiotic and betadine solution as well as use of a funnel has greatly decreased the risk.

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 20 reviews

I am becoming very concerned about capsular contracture. What do you think?

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Hello! Thank you for your question! Physical examination will determine if you have capsular contracture. The look and feel of hardness surrounding your implant is seen and/or felt. It may also cause distortion of your breast. What has caused it will be in question.

Your surgeon will likely recommend implant massage and may add the medication Singulair.  If these fail, surgical correction may be suggested. It is a matter of surgeon preference as well as what is seen during your procedure that will determine whether or not a complete capsulectomy is performed. If significant capsule formation is seen intraoperatively, a full capule removal may be warranted with a drain in order to completely remove all of the tissue and allow better adherence of your breast back to its normal anatomic position down on your chest wall. Irrigating with certain medications may also be if benefit. If minimal contracture is seen, it may be possible to leave the capsule, or place cuts within the capsule to allow better adherence. It truly is dependent on what is seen with your capsule and the issues that may be causing you to have such a procedure (e.g., contracture from rutptured implant vs pain vs simple pocket adjustment, etc).

Without knowing your issues and without an examination, it is difficult to tell you what may be the best thing for you. I tend to favor performing capsulectomies in order to create a fresh pocket, reshape the pocket, allow better shape and adherence of the overlying breast. I would discuss your issues with your plastic surgeon who will assist you in determining the right modality for you. Hope that this helps! Best wishes!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 28 reviews

Possible Capsular Contracture

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If you've just recently noticed that your breasts have changed in shape, feel, and how they project from your body, then you're right - you could be developing capsular contracture. While you can feel for yourself for any changes that indicate capsular contracture (signs include hardness, swelling, pain, and a rounder, more ball-like shape), please book an appointment with your surgeon who may examine you to see if it actually is. Your examination sometimes can involve an ultrasound, mammogram or MRI. The sooner you do this, the sooner you can be diagnosed and treated. Earlier detection is always better.

Treatments for capsular contracture include medications, therapeutic massage and stretching, as well as implant removal/replacement. Good luck! 

Capsular Contracture after Breast Augmentation

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I would recommend visiting your plastic surgeon to examine you.  Capsular Contracture is a clinical diagnosis and best made by the feel of the implant in the breast pocket.  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

Paul S. Gill, MD
Houston Plastic Surgeon
4.8 out of 5 stars 95 reviews

Capsular contracture vs tight implant pocket

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You clearly have excess firmness of the capsule around the implant which could be related to:

1) True capsular contracture 


2) A fairly tight capsule from a small pocket formation at the time of surgery. 

Either way, in my opinion surgery is indicated.  Either capsulectomy with new implants for capsular contracture or capsulotomy with rrelease of the capsule inferiorly and laterally and replacement of the same implants f a non-pathologic capsule is found.

York Yates MD - Utah

York Jay Yates, MD
Salt Lake City Plastic Surgeon
4.9 out of 5 stars 189 reviews

Capsular Contracture

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Unfortunately you have a capsular contracture which is significant scar around the breast implant.  The only good option is to re-operate.  If on top of the muscle i would place them underneath.  Maybe consider a little smaller implants. 

Medication is a option but best for type 1 and 2 contractures.  There are 50 to 60,000 new contractures each year. Common.

good luck.

Miguel Delgado, MD
San Francisco Plastic Surgeon
4.8 out of 5 stars 81 reviews

Capsular contracture vs small pocket

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You really need to see a  board certified plastic surgeon who can examine you and can tell what is going on with your breasts. Pictures just don't tell the whole story. In my experience implants placed under the muscle tend to ride higher than ones on top of the muscle and high profile ones tend to have a sharpe, less gradual transition between the chest wall and the breast. This is more noticeable with larger implants. So I would be more inclined to think your problem is not a capsular contracture but a combination of implant pocket size and location and implant size and shape. If you are happy with the way you look, there would be no need to change it but if you don't like your look, then surgery would probably be necessary. Good luck to you.

Margaret Skiles, MD (retired)
Sacramento Plastic Surgeon

Implant capsules

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Based upon your photos, it looks like you have a capsular contracture that probably needs removal of the capsule and replacement of the implants.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Concerned about capsular contracture

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It appears that from your progression photos that you are demonstrating some form of capsular tightening. It is possible that some of this was the initial procedure as you describe this, but you do show some degree of progressive tightening. Clearly there is limited movement of the implants as well. 

The treatment for either is the same with a release of the capsule to allow for the implant to sit more naturally on your chest. Some patients do show improvement with the off label of Singulair - an asthma drug - but you  would need to talk to your surgeon about this.  Otherwise, it is likely you will need a surgical revision to improve the appearance and feel of your breasts.

Best of luck,

Vincent Marin, MD
San Diego Plastic Surgeon

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

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.