What could be wrong with right breast? (photos)

I am 10 months post op 360 silicone under implants. Two different looking breasts (I know is normal) but left is soft movable and different shapes? My right is high, larger, rounder and also feels tight and achy and much more firm, even after 10 months , could something be wrong or ? I

Doctor Answers 9

Breast asymmetry

You had two different breasts to begin with as is the case for everyone.  Each breast will feel different due to anatomic differences. Good luck.

New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Problem with right breast

I'm sorry to hear about your right breast issues after breast augmentation. From you pictures there was significant asymmetry before the operation. Sometimes this is the root cause of issues afterwards. However with your description I am concerned about capsular contracture. This is a process of extra scar tissue than can be the result of a small amount of bleeding or low level infection. I would have this checked out by your plastic surgeon. Sometimes an ultrasound of the breast can be helpful as a seroma can have the same symptoms. 

Eric Weiss MD 

Eric Weiss, MD, FACS
Orange Park Plastic Surgeon
4.9 out of 5 stars 33 reviews

Uneven breasts

Sometimes there are differences between how an implant settles on one side compared to the other. Many times the muscle on one side is tight and may be under released, keeping the implant higher for longer. If you are still dissatisfied at one year discuss your concerns with your surgeon 

David R. Alfonso, MD, FACS
Grand Rapids Plastic Surgeon
5.0 out of 5 stars 54 reviews

What could be wrong with right breast?

Thank you for your question. You have some asymmetry before surgery and it carries after to a certain degree. Tightness and discomfort are associated with capsular contracture. Please see your Surgeon for evaluation.

Ven Erella, MD
Austin Plastic Surgeon
4.9 out of 5 stars 32 reviews

Probable capsular contracture

Sorry to hear about your asymmetry.  You probably have a capsular contracture.  Here is some info that may be of assistance to you.  

WHAT IS A CAPUSLAR CONTRACTURE?  Whenever any synthetic device is implanted in someone, the body will form a scar tissue capsule around the object.  The good news is that this scar tissue capsule can help hold the weight of the breast implant and thereby reduce the tendency to droop over time.  However, in some women (for reasons we don’t fully understand), the scar tissue capsule can shrink and squeeze the implant.  We call this a “capsular contracture”.  If this occurs, the breast will feel firmer and the implant typically takes on the form of a sphere.  The capsular contracture can also change the shape or position of the breast implant.  Typically, the implants are displaced upward.  Eventually, if the contracture process continues, women can have chronic pain in the affected breast.

WHAT CAUSES CAPSULAR CONTRACTURE? Factors that increase the risk of capsular contracture include trauma, bacterial infection, excessive blood or fluid (i.e. “hematoma” or “seroma”) in the breast pocket, free silicone (from a ruptured implant), smoking, and radiation (such as that used in cancer treatments). To prevent capsular contractures, we use meticulous surgical technique to assure complete sterility and insure that there is no bleeding at the end of the case.  We also use powder-free gloves, antibiotic irrigation, and a “no touch” technique (the implant never touches the skin or surgical drapes).  The implant is either in its’ sterile container or we are inserting it in the patient.  Only the surgeon touches the implant (never the scrub tech or nurse.)  The “cleaner” the implant, the less likely a capsular contracture will form. Also, patients with smooth implants are instructed on how to do proper breast massages to further minimize the chance of contracture.  Finally, some studies showed that textured implants may reduce the likelihood of capsular contractures, but other studies failed to show any benefit. 

HOW DO YOU TREAT A CAPSULAR CONTRACTURE WITHOUT SURGERY?  For patients with smooth implants, massaging may help.  The massages can be a little uncomfortable, but if they are painful, you are putting too much pressure on the implants.   Oral Vitamin E along with multivitamins has also been shown to be beneficial.  There are no definitive studies as to the exact dosage, but 400-800 IU of Vitamin E per day should be adequate. Anti-asthma medicines such as Accolate or Singulair have been used with limited success. This would be an “off label” use of these medications which means the FDA has not studied these medications for capsular contracture.  Singulair and Accolate should be taken with caution because of potential lethal complications such as liver failure.  Another option would be Erchonia Laser treatments.  They are performed 2-3 times per week (not on consecutive days) for a total of 12 – 20 treatment sessions.  We have seen that about half of our patients with early capsular contractures responded to this therapy and did not progress to surgery.  Anecdotal reports have also shown that a scar-regulating enzyme capsule called Neprinol AFD may be of some help.   

WHAT ARE THE SURGICAL OPTIONS FOR CAPSULAR CONTRACTURE?  The surgical options have varying degrees of success.  The simplest operation involves cutting the scar tissue capsule and replacing the old implant.  Nationwide studies show that this has the highest recurrence rate (over 50%).  Removing the entire scar tissue capsule, putting in a new implant, and possibly changing the pocket location (with respect to the pectoral muscle) as well as putting in an Acellular Dermal Matrix (ADM) has the lowest recurrence rate (up to 12% in some studies).  At Premier Plastic Surgery, when we combine surgery with the Erchonia Laser, our recurrence rate is 2-5%.  

Victor Ferrari, MD, FACS
Charlotte Plastic Surgeon
5.0 out of 5 stars 36 reviews

Tight and achy breast

If you feel tightness and discomfort  and disfigurement associated with your breast, it could be signs of capsular contracture.  Be sure to visit your surgeon to get evaluated as this is correctable.  Good luck.

Zachary Farris, MD, FACS
Dallas Plastic Surgeon
5.0 out of 5 stars 19 reviews

One breast implant sits high, is rounder and feels tight and firm

Thank you for asking about your breast augmentation.

  • Your description suggests that you are forming a capsular contracture.
  • This is not a health hazard but can be painful and change the appearance and feel of your breast.
  • So return to your surgeon to be examined and discuss treatment.
  • There is a medicine that can be tried that often will soften these capsules at least temporarily

Always see a Board Certified Plastic Surgeon. Best wishes  - Elizabeth Morgan MD PHD FACS

Elizabeth Morgan, MD, PhD
Atlanta Plastic Surgeon
4.6 out of 5 stars 43 reviews

Whats wrong?

Thank you for your question and providing photos. Based on your description and without a physical exam it sounds like you maybe developing a capsular contracture. As you know your breasts did have some asymmetry before surgery which will persist after surgery. I would recommend you see your PS. Best of luck

Christopher J. Morea, MD
Raleigh-Durham Plastic Surgeon
4.9 out of 5 stars 191 reviews

Firm breast

Our goal is to always achieve a soft, mobile breast that closely resembles the feel of a natural breast.  Unfortunately, at times the capsule around the implant can thicken, contract, or both.  If your breast feels firmer than expected, you should see your plastic surgeon.  There are things we can do to improve the hardness around the implant.

Samuel Beran, MD
New York Plastic Surgeon
4.9 out of 5 stars 6 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.