1 year postop - Do I have capsular contracture and do I need a Breast Augmentation revision? (photos)

Question

I'm pretty positive that I have capsular contracture but I won't know 100% until I'm able to get in for a consultation. I will be a year post-op on January 28, 2022. Just looking for any general feedback and next steps, does it appear that my only solution is another surgery?

Jose A. Munoz, MD · Answer

Hi and welcome to our forum!From your photos, I note bilateral high riding implants. Symptoms of capsular contracture range from mild firmness and mild discomfort to severe pain, distorted shape of the implant, and the ability to feel the implant (palpability). Capsular contracture is graded into 4 levels depending on its severity. Grades III to IV are considered severe and often additional surgery is needed to correct these grades:Grade I: the breast is normally soft and looks naturalGrade II: the breast is a little firm but looks normalGrade III: the breast is firm and looks abnormalGrade IV: the breast is hard, painful and looks abnormal.Following the procedure of saline or silicone augmentation mammoplasty, the surgical wounds seal and undergo the healing process. This occurs in the underlying soft tissues as well. The silicone polymer making up the shell of the breast implant is biologically inert, and as such, the body creates a thin filmy internal scar which surrounds the implant, holding it in its position. Thus, all breast implant procedures involve the development of a thin capsule. This becomes problematic only if the scar thickens and shrinks substantially around the implant, thus causing a capsular contracture. Manufacturer publications state that this will occur in approximately 10% of all augmentation procedures. Generally, capsular contracture only needs to be addressed if the patient experiences discomfort or if the implant becomes displaced, affecting the aesthetic outcome.The precise cause of capsular contracture is unknown but is unique amongst individuals and their individual immune response to the placement of a foreign body. Its incidence is increased in the presence of infection. Capsular contracture is not predictable nor a by-product of surgical quality. It is highly recommended patients learn and follow a massage routine that will dramatically reduce the incidence of contracture. Orally administered Accolate (and other oral leukotriene inhibitors) appears to lessen the severity of the phenomenon, but not extremely well in my experience. While postoperative massage will help prevent contracture, there exists the possibility that the degree of contracture may require an outpatient procedure to remove the scar tissue.Surgical capsulotomy or capsulectomy may be required. 15% of cosmetic surgical procedures may require a touch up. Maintain followup with your plastic surgeon.Best wishes...

Martin Jugenburg, MD · Answer

Hi thank you for your question. It is difficult to say based off your photos whether or not you have a capsular contracture. There are different degrees of capsular contracture. If you have a Grade 1-3 it can be subtle and you will need a proper physical examination to determine this. The best way to find out is to contact your Surgeon and be seen in person.

Stefan Mark Szczerba, MD · Answer

Hi,

Yes, the best way to evaluate for capsular contracture is by physical exam. Your surgeon will evaluate your implants for position, stiffness and any irregularities. Usually, it takes a year before your surgeon can determine if anything else needs to be done. For now, continue your implant massage. Best wishes!

Vasileios Vasilakis, MD, FACS · Answer

Thank you for the question. Even with the photos, it is very hard to make an accurate assessment and give you advice without an in-person evaluation. Your surgeon will determine whether you have capsular contracture and guide you accordingly. I wish you the best of luck. Vasileios Vasilakis, MD. Fellowship-trained plastic surgeon. Houston, TX.

Donald R. Revis Jr, MD · Answer

Good morning,
From your photos you either have bilateral CC's or it could just be that your implants never dropped and fluffed. This could be distinguished by having your PS examine you. Also I would want to measure you to make sure your nipple position isn't a llttle low and needs to be lifted. Your preop photos would also help in this determination if you wish to post them!

Daniel Barrett, MD · Answer

Dear ErinMichele205,
I understand your concern. However, without a proper assessment, it would be difficult to determine what went wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Nelson Castillo, MD · Answer

Thank you for sharing your question and photographs.  It is difficult to comment on what may be taking place without seeing before images and performing an in-person examination of your tissues.  Certainly a surgical revision will be needed in either case to improve upon your current results.

Camille Cash, MD · Answer

It is possible that you have capsular contracture.  Depending on the degree, your surgeon may have you try Singulair for treatment.  In more severe cases the correction is surgical removal of the implant and capsule.  I've included a video about capsular contracture that I hope you find helpful.

Joshua B. Hyman, MD · Answer

Thanks for the question. It is possible you have early capsular contracture but it looks more like mal position of the implants. It is possible the muscle was not released enough or you were not placed in a breast strap after the surgery. Sometimes the details make the difference between a perfect result and your situation. Make sure you are using a board certified plastic surgeon and I am sure they will ultimately be perfect.

Connie Hiers, MD, FACS · Answer

An examination is needed to see if you have capsules or if your own breast tissue is sagging. Your surgeon will be able to determine this. You may even have some of both.

1 year postop - Do I have capsular contracture and do I need a Breast Augmentation revision? (photos)

Answers (11)

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