Left breast full capsulectomy and exchange Implant 700cc. I am 5'2 130 pounds. (photos)

I am one week post op and I was concerned that my Dr didn't put a Drain on me! Do you think i need one? And also was wondering is my left breast having hematomas or just bruising! Thank you for your time

Doctor Answers 4

Hematoma

Hello,

Unfortunately, it appears you have a fluid collection, likely bloody. So, you could call it a hematoma. You either should have an elective surgical evacuation (my recommendation), or ultrasonically guided percutaneous aspiration. I'm very sorry, but a drain would not have avoided this problem. Best of luck.


Beverly Hills Plastic Surgeon
4.9 out of 5 stars 79 reviews

Drain after capsulectomy and new implant?

It appears as if you had only your left breast operated on, and complete capsulectomy is a "big" operation with extensive dissection, along with expected swelling and some bruising. Certainly a hematoma is possible, but drains do not prevent hematomas, and a tube that goes from the inside to the outside to let fluid OUT can also act as a conduit (actually a "superhighway") for microscopic bacteria to get IN. This would only increase the possibility of bacterial biofilm and recurrent capsular contracture (CC). So, NO, a drain is almost never a good idea, especially in this setting, or any place an implant is involved.

A hematoma can usually be easily diagnosed, and if present should be dealt with (surgical drainage, not a drain tube) promptly to minimize the risk of bleeding contributing to recurrent CC.

Since it appears as if about 45-60g of capsular scar tissue was removed, I hope your surgeon also used an appropriately-larger implant to compensate for this, even if you do look asymmetrically-swollen right now--it's the long-term symmetry that counts. Your surgeon seems to be right on target, even if your own understanding of the details was what stimulated your concern and questions. Best wishes! Dr. Tholen

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
4.9 out of 5 stars 239 reviews

Left breast capsulectomy and implant replacement

Dear bellapirata,

   Thanks for submitting your pictures. Well , first let me congratulate you for choosing a surgeon who did the right procedure for "Biofilm" capsule contracture, which is capsulectomy and replacement of implant.

  In regard to placing a drain in the pocket , in a procedure like you just had, it depends on the surgeon's assessment of the bleeding in the pocket. I, myself, rarely use drain in procedures like yours, because when the entry incision is made like you had (sub areola) it is easy to control the bleeding. So only in rare situation when there is un controlable bleeding ( eg - patient took Aspirin etc) there might be an indication for a drain , in my opinion.

  As far as your bruising, it is moderate and could be from the injection of the local anesthesia. As long as the breast is soft, the bruising will disappear in 2-3 weeks.  In any event, if you are concerned, call your doctor's office and schedule an appointment, because , if indeed you have hematoma, it needs to be evacuated asap, in order to reduce the likelihood of capsule contracture.

                          Best of luck,

                                                Dr Widder

Asymmetry

From your story and photographs it appears that only the left side was operated on, hence it is more swollen and bruised compared to the right. Some amount of bruising is certainly possible after a capsulectomy. The placement of a drain is entirely up to each plastic surgeons protocols. Some use drains and some do not. You can make arguments for each. Having a drain will not prevent a hematoma. A small office ultrasound can readily discern whether there is blood and or fluid around the implant which could be alleviated by a drainage procedure. Your plastic surgeon will be your best resource to answer that question. Best of luck.

Marc J. Salzman, MD, FACS
Louisville Plastic Surgeon
4.7 out of 5 stars 44 reviews

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