Early Capsular Contractor OR Right Breast Just Not Dropped Yet? (photo)

Hi, I'm 6wks post-op, 275cc Silicone HP, Submuscular-crease incision.. My left breast seems to be fully dropped into pocket and I can freely move implant around, my left is soft but not a pliable/doesnt move as freely in pocket. Also, appears to me that right rides higher on my chest Note:My left breast was a little bigger than my left pre-op/ Right is my dominate side wondering if early stage CC? Or maybe implant hasnt dropped into pocket Will C my PS in 2wks to confirm thank you for your time

Doctor Answers 6

Breast asymmetry

Each breast responds a bit differently with implants and settle at different rates.  Give it some more time.

New York Plastic Surgeon
4.1 out of 5 stars 28 reviews

Breast Asymmetry Six Weeks After Augmentation: Early Capsular Contracture vs. Just Needs More Time

Knowledge of the pre-operative appearance of your breasts is necessary, along with a physical examination that includes an assessment of implant mobility, to help reach the proper conclusion.

The fact that your right breast was a little smaller than your left breast may account for some of the differences you see now. The right skin envelope would be tighter and would need to stretch more to allow the right implant to settle properly. The greater the size/shape difference, the more this may play a role in what you see now.

Was your right breast positioned higher on your chest pre-operatively? If the inframammary incisions were placed in your native inframammary folds (IMF) it would appear that your right IMF was (and still is) higher. That means that the right implant is positioned higher on the chest wall and will have more upper pole fullness compared to the left. This may give some illusion that the right implant has not dropped as much as the left implant.

Although everyone usually refers to the post-operative changes in implant position and shape as ‘dropping’, descent’, ‘settling’, or whatever similar term is used – this occurrence is less about vertical descent of the implant, and more about volume redistribution within the implant. As the swelling decreases and the breast tissues relax and stretch, the implant probably does descend a small amount; but there is more significant volume redistribution from the upper portion of the implant to the lower portion of the implant, which subsequently accounts for the flattening of the upper pole of the breast and increased volume/fullness and projection in the lower pole of the breast.

Implant displacement exercises may assist with soft tissue stretching and implant settling, and may reduce the risk of capsular contracture.

Sometimes implants can take several months to settle in, and sometimes the implants will settle at different rates. But generally speaking, in most individuals with relatively symmetric breasts, the implants will settle at the same time and rate, and will be well on their way by six weeks post-op. I don’t say that to concern you, but just to mention my overall experience. You will still see changes in the appearance of your breasts over the next few months, and there is certainly time for more progress on the right side.

Overall, the right breast looks smaller, narrower, less round, and less projecting. Some of these would not be unexpected given the mild pre-operative asymmetry you mentioned. There appears to be less breast tissue on the right, the base width of the right breast is more narrow (pre-op vs. pocket dissection vs. capsular contracture), and the distance from the right nipple-to-IMF is shorter. Your statements about implant mobility confirm what I would expect based upon the photographs you provided. Without any other knowledge to base my opinion on, and since your pre-operative asymmetry does not sound significant, I would have some concern for an early capsular contracture and would take appropriate steps to try to alleviate this. If the right implant does not drop below the level of the scar and/or the right inferior pole does not stretch the right implant will remain higher and you will likely have more upper pole fullness on the right side.

Your surgeon should be able to guide you as you continue to heal.
Best wishes. Ken Dembny

Kenneth Dembny, II, MD
Milwaukee Plastic Surgeon
4.9 out of 5 stars 34 reviews

Early Asymmetry after Breast Augmentation

6 weeks is still very early in the healing process and you should expect some ongoing changes with your breasts. It is not uncommon to have some differential settling of implants after surgery. 

Looking at the pictures you provided, it does appear that the right side is slightly higher than the left, but this may be magnified by the fact that the distance underneath the right nipple/areola is shorter than the left. I suspect that this was there pre-operatively as well. I would encourage you to discuss your concerns with your surgeon. (S)He will be in the best position to compare your current appearance with the pre-operative photos and assess how you have progressed over the past 6 weeks since surgery.

Lawrence Iteld, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 39 reviews

Early capsular contracture or healing process?

At six weeks postop, you are probably going through the healing process and it's normal for one side to heal more quickly than the other. The implants won't necessarily drop simultaneously. That said, you should definitely see your plastic surgeon in followup because photos are never a substitute for clinical examination.

Robert L. Kraft, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 40 reviews

Early capsular contracture or not

At six weeks, it is more likely the implants have not fully dropped than it is to develop capsular contracture, although possible. You should consult with your board certified plastic surgeon to be evaluated and reassured.

Todd C. Case, MD
Tucson Plastic Surgeon
4.9 out of 5 stars 55 reviews

Honestly, it could be either early capsular contracture OR simply implant not yet dropped!

Your description and photos are great, but unfortunately do not take the place of an actual in-person physical examination and assessment of implant mobility. And frankly, even this may not allow your surgeon to conclusively rule either option in or out.

Fortunately, it is early, and the only thing certain is that there WILL be additional changes in both breasts. Unfortunately, whether or not those changes are in the direction of improved symmetry or increased asymmetry is impossible to predict. Only time will tell.

But, your surgeon may have some advice as to maneuvers or medications to consider that may actively aid positive direction of your healing. Ask about implant movement exercises, elastic bandeau worn at night above the high breast, and possible use of oral Accolate or Singulair and Vitamin E. Ultrasonic treatments can also be considered in appropriate cases.

For now, stay calm and follow your surgeon's advice! Good luck and best wishes!

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
4.9 out of 5 stars 255 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.