Opinions on what to do with indented capsulorrhaphy breast revision?

Dear 0.0,
I understand your concern and it is quite normal to be concerned about the outcome following a breast revision surgery. However, you are still in the early stages of the healing process.Your will need to be patient at this moment and follow what your surgeon has instructed you to do post operatively.At the early stage of the healing process, the tissues are still swollen. Once the swelling subsides, you will be able to see the final result of your surgery.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Operating immediately to correct something is a tempting option, but this can lead to unnecessary operations and potentially further complication.  Often, waiting to see how the scar tissue heals is the best option.  Sometimes no operation is necessary after some time for the scar to stretch and settle, and almost always if you do need to operate the operation is easier because the tissue is less stiff and fibrotic and your surgeon can make smaller, more subtle corrections as necessary.

Sooner is not better, and capsulorrhaphy sutures typically loosen. Going back in now is not recommended, and if your doctor is experienced, he would refuse your request. Time will likely be on your side and revision may not be necessary. 

At this point you may need to wait at least 6 months to allow things to settle and stretch.  You may be fine over time or this may be permanent.  I would monitor it and see where you are at in 6 months.  If it looks like it is improving then I would say wait longer and see if it corrects it self.  If at 6 months things look the same then you may need revision surgery to fix this.Hope that helps.

With traditional capsulorrhaphy the inferiolateral area is easily over-tightened, which is what is shown in your photo.   Depending on the structure of the capsule and type of repair this could be a permanent or temporary issue.   It would be a good idea to wait for at least 3 months to see where it is headed and then revision may be necessary.  If revision is necessary I have found a valuable tool is "popcorning" the capsule.   Essentially adding "heat and energy" to the capsule with a bipolar cautery device to shrink the capsule to the position and dimension you like and then support this position with sutures.   This helps prevent precisely the issue you are having with over-tightening in some areas and under-tightening in others. You may ask your surgeon if He/She has any experience in that technique.   It is on the short list of my favorite tricks I have found in the past decade.   

With a capsulorrhaphy, it is not just the type of suture but the tissue that is being sutured that creates the long-term result. Since capsulorrhaphy is often done because the capsule has thinned allowing the implant to shift, it is not always strong enough to hold the repair. For that reason you may see some softening over time and if you can wait 6-12 months it might be best. 

It will be best to wait and let all the swelling subside and the tissues soften before trying another repair if it is needed. Sometimes, things do settle out well and need no revision. I  would suggest waiting until 6 months after the last procedure.

I personally used long term dissolvable sutures so that these dents always go away but in your case, it is critical to wait several months and re-evaluate as they may well settle out.