I am now 7 weeks post op, capsulorraphy on the left breast and capsulectomy on my right breast? (Photos)

Is this severe capsular contracture? I used my right arm minimally to avoid this! Is it normal to have a lump or knot on the side of my breast next to my ribcage? My surgeon released me one week ago and said everything is fine and that the pain is normal. I can't lay on my right side or my stomach. My right breast is hard, painful and doesn't move with massage. Is it too late for Singulair? What can be done to fix this for the second time?

Doctor Answers 5

Post Op Concerns

Hello,


Thank you for your question and photos. You will need to discuss the specifics of your case and treatment with your Plastic Surgeon as they know your situation the best.


Take care

Capsular contracture

Sorry that you are having a problem with your surgery.  Based on your pictures you appear to have some degree of contracture.   In your most recent picture your right implant sits higher than the left implant. Unfortunately you most likely will need a surgery to lower the implant.  Goid luck.  

Jon E. Rast, MD
Kansas City Plastic Surgeon
5.0 out of 5 stars 28 reviews

Recurrent capsular contracture

This is the most frustrating problem in aesthetic breast surgery. You might get some benefit from oral medications and aggressive massage but most likely it will require surgery. 

The opinions on the treatment of capsular contracture has gone through a lot of changes over the years and many of the prior recommendations that were touted as "state of the art" turned out to be wrong in the long run. Also the use of acellular dermal matrix has been met with mixed results and in addition is extremely expensive for the patients. 

We have found that at a minimum implant exchange with complete removal of all scar capsule is necessary and then , if possible, change to a new pocket . If your implant was sub muscular ( as it appears yours is) and the new pocket is now going to be subfascial then it would be a good idea to consider converting both sides to subfascial with a textured anatomic gel implant for symmetry. However, it may not be something you want to consider redoing both sides. So , for unilateral correction in patients such as you, we have found that treatment with total capsulectomy, implant exchange, and then coverage of the new implant ( smooth surface) with a micro thin wrapper of gortex around the implant as opposed to an acellular dermal matrix to be very effective in most cases. In our hands the ADM has not been as effective as the gortex and is much more expensive (2,000 dollars versus 300 dollars). 

Ask your surgeon what has worked for him. 

Grady B. Core, MD
Birmingham Plastic Surgeon
4.5 out of 5 stars 11 reviews

I am now 7 weeks post-breast revision surgery.

Thank you for sharing your question and photographs. I am sorry to hear of your capsular contracture and implant malposition issues.  Unfortunately without an in-person examination it is difficult to offer definite advice as your right side does show concern for a recurrent encapsulation.  Treatment typically requires capsulectomy, use of new implants, conversion from a subglandular to submuscular position, and use of an internal tissue scaffold.  Hope this helps.

Nelson Castillo, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 43 reviews

Breast implant encapsulation concerns...

I am sorry to hear about the complications you have experienced. Capsular contraction can be a very frustrating complication for both patients and surgeons.  In my practice, I have found the most success treating these difficult problems utilizing techniques such as sub muscular pocket conversion (if relevant), capsulectomy, use of fresh implants, and the use of acellular dermal matrix (especially for recurrent encapsulation).  Acellular dermal matrix is a biologic implant that carries the ability to become integrated into native tissue. It is made by taking a full thickness section of skin from a donor source (his human, porcine, or bovine in origin).  



Personally, I think that if the breast is "painful and hard", the use of anti-inflammatories such as singular will likely not be effective.



I hope this, and attach link ( demonstrating a case utilizing acellular dermal matrix) helps. 

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.