I Have Had These Implants for 8 Months and Got 450 Cc Silicone. My Left Breast Feels More Firm? (photo)

My surgeon tells me to keep taking singulair and there is nothing to worry about but I am concerned. My implants look fine with my arms down standing but the left looks deformed if I raise my arms or lay on my back. Does this seem like capsular contracture and what should my next step be?

Doctor Answers 8

Left Breast More Firm, Right Breast Bottomed Out

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   It is possible that your left breast has capsular contracture, and you may need surgery for that.  The right breast appears to have bottomed out, and you can have surgery to correct that as well.  It would be helpful to have preop and postop pictures of you standing with the arms at your side.  This would give a better idea of implant position and symmetry.  Kenneth Hughes, MD Los Angeles, CA

Does this seem like capsular contracture and what should my next step be?

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I would wait until you are at least six months from your breast surgery before any conclusions are reached. Singular has been shown in some medical studies to help some patients. I believe in your case Singular cannot hurt. At this point in time,  I believe it is too early to tell if you have  breast implant capsular contracture. I believe the most important determinants of capsular contracture are the type of implant used,  the location of the implants,  your surgeons technique,  and your immediate postoperative healing. I believe the lowest incidence of breast capsular contracture is achieved with silicone implants placed underneath the muscle. Surgery should be minimally traumatic. Collections of blood (hematoma) or infection can increase the risk of breast implants capsular contracture.

In your case,  I would wait until you are  six months from surgery.  At that time, things should have healed sufficiently and one can  determine if you need surgery.   Hopefully, you will not need any surgery. At the other extreme,  if you do need surgery, this may require removal of scar tissue around the implants (capsulectomy) and / or  perhaps exchange of your breast implants. Good luck

J. Timothy Katzen, MD, FACS
Los Angeles Plastic Surgeon
5.0 out of 5 stars 254 reviews

Capsulotomy is sometimes the best option

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You should schedule a follow up appointment with your plastic surgeon. He will be able to determine if you have developed the capsular contraction. Usually patients notice certain changes in a breast within time like a pain, firmness, asymmetry and changes in implant position. In case that capsular contraction is diagnosed depending on the degree of the problem there are two options. The singular can be prescribed or you will have to have the procedure done to release the capsule. The procedure is done under general anesthesia and usually is very succesfull

My Left Breast Feels More Firm

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If the left breast feels clearly firmer, this is probably a capsular contracture.It would be helpful to see a standing up frontal view, because it also seems that the left breast fold is a fair amount lower than is the right, and the nipples are not even.  I wouldn't be much concerned 

I don't know how long you have been taking singulair but if it has been more than a few months and it has not improved, it is not likely to. 

Next step should be a visit to your surgeon, or for a second opinion to another surgeon. 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon

Do you have capsular contracture?

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You did not mention the hardness of the breast tissue. You have uneven pocket and asymmetry that can be corrected to some degree. Your before picture can be helpful.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.8 out of 5 stars 154 reviews

Breast Augmentation Asymmetry, Capsular Contracture?

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From the pictures that you provided it does appear to be a capsular contracture. With that being said, this can only definitively be determined through a physical examination.


Capsular Contracture is an overproduction of scar tissue that can sometimes form around the pocket where the implant has been placed. Often side effects include pain (depending on the level of the contracture), implant hardness, disfiguring of the implant, and resulting implant asymmetry. The following Baker Classification is a scale that was implemented to help determine the severity of the capsular contracture:


Baker I: the breast is soft, it feels and looks natural

Baker II: the breast is slightly firm, mild asymmetry in palpability, but with no visible variations

Baker III: the breast is significantly firm, there is a visible change in the appearance of the breast

Baker IV: the breast is very firm, there is significant visible changes in the shape and location of the breast, pain with normal activities or mild palpitation


Generally speaking, the treatment for a capsular conracture would be a capsulectomy or capsulotomy (although every situation is different). These are surgical procedures done under general anesthesia where the implant and the capsule surrounding the implant are either removed or scorred in an effort to remove or release the capsule. Depending on the wishes of the patient, an implant can be replaced and any lifting techniques can be done at the same time.


You should take into consideration, that although this is treatment for the current capsular contracture, reoccurence is common. It is important to follow all post-operative instructions given to you by your doctor (including physical exercise limitations and massaging).


I hope this helps you and good luck


Fadi Chahin MD, FACS

Plastic and Reconstructive Surgery

Diplomat, American Board of Surgery

Diplomat, American Board of Plastic Surgery


Fadi Chahin, MD, FACS
Beverly Hills Plastic Surgeon

My Left Breast Feels More Firm

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Thank you for the question and the photos. It would be important to know if the firmness has been present since surgery or it has developed over time. This as well as an in-person examination may help elucidate whether it is a capsular contracture or a problem of the implant pocket.

I would recommend that you discuss your concerns with your surgeon as at least from the pictures it would appear that a revision may be in order. If after your consultation you remain dissatisfied then seek a second opinion in person.

Breast augmentation asymmetry

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Thank you for the question and the photos.  If your left breast is getting progressively firmer than it is almost certainly a capsule contracture.  If your left breast has been firm the entire time then it might be a pocket symmetry issue.  I think the asymmetry is noticeable enough that a revision should be discussed.  If capsule contracture is the issue a full capsulectomy (capsule removal) will have to be performed and the implant exchanged.  In addition you and your plastic surgeon may want to entertain the idea of ADM (acellular dermal matrix) as this may lower your chance of a second capsule contracture.

All the best,

Dr Remus Repta

Remus Repta, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 173 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.