I write this on behalf of my friend. She had breast augmentation 3 weeks ago with the incision in the armpits. Four days ago, she started to notice a 'dent' on her right breast (see the picture). Her surgeon said she got capsular contracture grade 1 and told her to massage her breasts to smooth out the dent. Then yesterday she found out her left breasts start to appear a 'dent'. Is it true that massaging can smooth out the dent like in the picture or she does need a revision? Her implants are smooth ones, and if the surgeon replaces the implants with textured implants in the same pockets, will she still get the same capsular contracture? And how much does the correction cost with another surgeon in California?
How to Fix the Dent on Breast Implants
Doctor Answers 13
Your friend need revision
The reason for the folds is due to the mismatch between the implants diameter and the pocket diameter. You can tell from the picture that the medial pocket was dissected too much and the lateral pocket was not. The surgeon tried to give your friend as much as cleavage as possible and over dissected the middle pocket. There is no indication for the capsular contracture. For the revision, you will need iframammary incision and I would wait at least 3 months before revision.
Breast "Dent" After Breast Augmentation through the Arm Pits
regarding: "How to Fix the Dent on Breast Implants
I write this on behalf of my friend. She had breast augmentation 3 weeks ago with the incision in the armpits. Four days ago, she started to notice a 'dent' on her right breast (see the picture). Her surgeon said she got capsular contracture grade 1 and told her to massage her breasts to smooth out the dent. Then yesterday she found out her left breasts start to appear a 'dent'.
Is it true that massaging can smooth out the dent like in the picture or she does need a revision? Her implants are smooth ones, and if the surgeon replaces the implants with textured implants in the same pockets, will she still get the same capsular contracture? And how much does the correction cost with another surgeon in California?"
This is NOT capsular contracture. In my opinion, your friend demonstrates what happens when the pocket into which the implant is placed is not made the same. The dent you are referring to is an incomplete release of the tissues due to the angulation of the arm pit and is a known pitfall with Transaxillary Breast Augmentation. Replacing the current implant with a textured implant will not correct the pocket - revisional surgery will correct the pocket. Different surgeons will charge differently for revising this situation.
Dr. Peter Aldea
No capsular contracture exists at 3 weeks
I would beg to differ with the opinion that what you are seeing is a capsular contracture of any grade at only 3 weeks. This implies that what you are seeing is somehow your body's fault making abnormal scar tissue. If you will notice, the same flattening is present on the lower outer opposite side which speaks against cc as an issue. Either your friend is wearing inappropriate garments and not following doctor's instructions as to care or the pockets aren't perfect and may need revision if time and massage don't resolve the problem.
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How to Fix the Dent on Breast Implants
The photo does not indicate capsular contracture. Her implant pockets were not created symmetrically. However, she is still very early in recovery, and this can change. I would recommend that she wear a breast strap, and elastic strap that fits tightly over the upper part of her breasts. This will help to strech out the pocket as the capsule is developing. This may help alleviate the need for revision surgery. She should wait at least 3 months before being too critical of her lower breast shape, as this can change during the early recovery. If at that time it has not changed at all, she should discuss her options with her surgeon.
This may settle with time slightly particularly if she could massage the breast downwards into this area
Thank you very much for including the picture of your friend, it does look as if she has a visible dent in the lower part of her breast and this is due to muscle tethering in this region holding the implant upwards.
This may settle with time slightly particularly if she could massage the breast downwards into this area but if it does not settle by 3 months I would advice her to seek a further consultation with her surgeon to discuss the options which may include lowering the breast implant and relaxing the muscle in the area.
Best wishes yours sincerely,
Plastic and Cosmetic Surgeon
Surgical Director of Aurora Clinics
Post-op Irregularities After Breast Augmentation?
All breast augmentation procedures take time to "settle" and allow the muscle and skin to stretch to accommodate the implant. This results in forces on the implant that cause them to look odd through the initial healing period. Time often settles this to produce a even and smooth result.
However, this is not capsular contracture at 3-4 weeks after the surgery as it takes 6 weeks just to get the collagen/scar tissue to the area. In this photo, it appears that there is significant flattening along the outer/lower aspect of the right breast. Thus, I would be somewhat concerned about how much this will relax over time or was this area not opened enough for the implant. Fortunately, the implant will correct much of this over time as the muscle and skin relax. It is possible that a small flat spot may persist. All of this should be managed conservatively and watch to see if all of this corrects itself on its own.
Tell your friend to have open communication with her plastic surgeon and seek out a second opinion as well.
Best of luck
Vincent Marin, MD, FACS
San Diego Plastic Surgeon
Too early to judge, but pocket may be insufficient
Dear Lady, 3 weeks after a breast enlargement is definitely too early to judge the appearance of the breast. One thing is sure : it is NOT a capsular contracture, because too early.
Possibly the implant is sitting a little too high, which is a common problem with a breast enlargement via the armpit. Massaging the breast most likely won't correct the problem.
I would advise to wait 2-3 months to allow the implants to settle. If the appearance then is still unsatisfactory, an enlargement the pocket downward will most likely solve the problem. A textured implant won't give a better result.
If I need to revise a surgery from another surgeon I charge the same fee as for a primary augmentation.
Irregularities after breast augmentation
It appears in the picture that the muscles are contracting which can create the appearance of a dent. Generally this is not something that has to be treated unless it progress and becomes more painful.
Capsular contracture at 3 weeks is highly unlikely
It is highly unlikely that your friend is experiencing a capsular contracture this early in her post operative period. Her photos show no evidence of a resolving hematoma which is the most common cause of an early capsule. What seems to be the case is that the pockets were not adequately created in an infero-lateral direction which is the case on both sides. That is what is causing the apparent dent and unnatural appearance. There is no advantage to switching to textured implants since capsule rates are comparable between the two. If vigorous inferior and lateral massage does not better position the prosthesis, she will need to have the pockets revised.