Left Nipple Dimpling Inward when I Flex Chest Muscle Muscle at 25 Days Post Op. Should I Be Worried?

You likely have scar tissue that is involved between your skin and the capsule (shell) around your implant. I would recommend massaging for now since it's still early from your surgery-the scar tissue may still soften. If this persists for several more months, you will likely need surgery to separate the scar tissue from its attachments to the skin.

Consult with your plastic surgeon for a more in depth examination.

Best wishes,

Dr.Bruno

You have most likely developed scar tissue between the undersurface of the skin and the chest muscle. That is probably the knot that you feel. You need vigorous massage to break up the scar. If you do not do this or if the scar dose not respond to this you will likely need surgery to divide the scar between skin and muscle.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

In breast augmentation with implants under the muscle using the dual plane technique, a portion of the pectoralis muscle is cut from its attachment to the rib cage. This is necessary because the point of attachment is higher than the bottom edge of the breast, so the implant would sit much too high; releasing the muscle attachment opens up space for the implant to sit. (That is why it is called dual-plane; the lower part of the implant is under the breast, upper part covered by muscle.) The problem that can arise is that the cut end of the muscle heals into the scar capsule, so when you flex you can see pulling. This can be either at the edge of the areola as the pictures you posted show, or lower, where it can also form a "double bubble." It is still early in the post-op period so it may improve with time. If not, you may consider converting to a split-muscle technique.

No way for me to know for sure with a formal exam, but it is my opinion that the "knot" that you are feeling is most likely some sutures used at surgery.  The indentation you note with muscle activity may be some scar tissue setting up in this area.  This may go away on its own, but discuss with your surgeon if he/she is open to you doing massage in the area at this time to possibly help the tissue settle down a bit earlier.  Best wishes.

The "knot" you are feeling is probably the sutures from within that holds the soft tissue together while it heals.  The indentation may or may not get better with time. Usually it improves.  It may need to be revised but give it time.

The dimple in the periareolar incision is caused by the way the tissue under the nipple has adhered to the chest muscle and implant capsule. The way we prevent this with the periareolar approach is to work from the incision down to the breast fold, and then back up and under the muscle to leave the breast tissue between the skin and implant. With massage the dimple may 'let go', though if it remains stuck the incision can be revised.

Best of luck,

peterejohnsonmd

The implant placement through the periareola incision has the risk of the scar depression and pull with muscle contraction.You need to talk to your plastic surgeon regarding your concerns and revision.

When you have breast implants placed through in incision around the nipple, there is scar tissue that extends from the skin, through the breast tissue, down to the capsule around the implant.  If the implants are under the muscle, regardless of the incision placement, there may be some distortion of the implant, and sometimes of the overlying tissues and even skin, when the muscle flexes.  The lower portion of the muscle is divided so that the implant can be in the proper position, and the muscle fibers may scar down to the capsule and to the overlying tissues.  Scar tissue is the way all incisions heal, but scar tissue can be unpredictable.  In your case, on your left side, the muscle fibers have healed in such a way that they have attached to the overlying breast tissue and scar tissue extending up to your incision, so that when the muscle flexes it pulls inward on the skin incision.  There is always some areas of thickening of scar tissue early after breast augmentation, so the "knot" you are feeling may just be that, or some scar where a small blood collection formed after surgery.  The "knot" should resolve over time.  You may require a revision in order to attempt to release that scar tissue adherence and the indentation that occurs with muscle flexion, if it does not lessen over time.  There may be some tendency for it to recur, depending on what revision is performed.