Capsular contracture or fat necrosis? (photos)

Question

Hi! Breast lift/reduction plus implants in Feb 2023 (10 months ago) and no issues since. Really happy with my results. I've noticed a small lump (at first thought it was thick skin along the scar line) with clear borders developing recently. I remember after surgery this exact area was bruised for months and had a small indentation. Now it has a hard, discolored lump. My surgeon said to get an ultrasound but I'm out of country right now, so I wanted to get a second opinion.

J. Timothy Katzen, MD, FACS · Answer

Hi Allie1891,

Thank you for reaching out with your concerns about whether you're experiencing capsular contracture or fat necrosis. Your detailed history and the provided pictures are incredibly helpful in assessing your situation.

Given the symmetry of the areas in question, it seems less likely that this is a case of fat necrosis. My inclination is that what you are experiencing is more akin to capsular contracture accompanied by scarring around the contracted capsule. This condition often arises in relation to the surgical technique used during your breast lift, particularly concerning how the breast pedicle was managed during the procedure.

When the breast pedicle is opened to facilitate the insertion of the breast implant, and subsequently closed—sometimes with permanent sutures—it can lead to such complications. The symmetry of the issue points towards this being a structural outcome of the surgical process rather than an irregularity like fat necrosis.

To accurately diagnose the condition, I would recommend undergoing an ultrasound, mammogram, or MRI. These imaging tests can provide clarity on whether it's capsular contracture or something else. Your treatment options vary based on the diagnosis and could range from conservative approaches and steroid injections to more invasive surgical revisions.

The course of action largely depends on how much this condition is affecting you. If it's causing significant discomfort or dissatisfaction, seeking a revision might be the right path. However, if the symptoms are mild, less invasive treatments might suffice.

I hope this provides clarity on your situation and helps you in deciding the next steps for your care. Wishing you the best in your continued recovery.

Sincerely,

J. Timothy Katzen, MD, FASMBS, FICS
Plastic and Aesthetic Surgeon

Gianfranco Frojo, MD · Answer

These could be just widened scars related to the lift. I would agree that an ultrasound would be beneficial to ensure that this is all they are.

Daniel Barrett, MD · Answer

Dear allie1891,
I understand your concern. However, without a proper assessment, it would be difficult to determine what is wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Wayne I. Yamahata, MD · Answer

The lump is more likely scarring or fat necrosis and not a capsular contracture. In general, it is not a good idea to ignore breast lumps and an examination by your surgeon would be recommended. As you are out of the country, an ultrasound would be a reasonable alternative. Depending on the findings, your surgeon may be able to simply remove the lump when you return home.

Ronald J. Edelson, MD · Answer

If I had a patient that had this and it really bothered them I would simply cut it out under local anesthesia. It would take 5 minutes and I doubt it’s anything serious. The ultrasound is a waste of time

Connie Hiers, MD, FACS · Answer

An examination and ultrasound is needed to see what it might be. No one over the Internet can tell you what this is exactly. Go see a physician in your area and be checked.

Capsular contracture or fat necrosis? (photos)

Answers (6)

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