Malposition? Capsular Contracture? Need Lift? What is Wrong with my Breasts? (photo)

I had my BA on July 26, 2012 325 CCs, under muscle, saline. Can you please look at my photos and give me your opinion? Since 2-3 months, I'm now 5 mos post op, they haven't dropped. They haven't gone upward any or gotten any firmer than they have ever been, which is why I'm skeptical as to whether it is capsular contracture or not. My PS has not said 100% that I do or do not have CC. He mentioned doing an open capsulotomy w/o implant change. I'm very frustrated and would like some insight.

Doctor Answers 16

Breast implants

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I doubt that you have capsular contracture.  the main problem is not that your implants are too high.  Your nipples are too low.  They need to be lifted.  This can be done along with slight lowering of your implants if you want. It's a pretty straightforward vertical lift that is required.  This can be done without even touching the implants.

San Diego Plastic Surgeon
5.0 out of 5 stars 28 reviews

Need a breast revision

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These are good pictures, but it is difficult to assess the problem without a physical exam and pre-operative pictures.  If the breasts are soft, you probably don't have capsular contracture.  You probably need a breast lift. 

Dennis Dass, MD
Beverly Hills Plastic Surgeon
4.8 out of 5 stars 180 reviews

What is Wrong with my Breasts?

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Thank you for your question and for the posted photos. More helpful would be the addition of pre op photos.

But based only on what is in this posting alone, I think you would be best served by a breast lift. Grade 2 capsules cause no visual distortion, but only firmness on palpation, so I cannot give an opinion on the presence or absence on contracture. (Grade 1 is normal and soft, grade 3 is firm with visual distortion of breast shape).

From the side and 45 degree angle view it appears that the implant position is satisfactory, but that the nipple and areola are too low. I fear that an attempt to lower the implant will result in "bottoming out" and will not solve the problem. 

Discuss with your plastic surgeon. If the suggested approach doesn't make sense to you, seek another opinion. 

Best wishes. 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon

Breast implants cannot always camouflage ptosis of the breast

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If the bottom of breast implant is sitting at the infra mammary fold, it is in the correct position. The nipples appear droopy and will require a mastopexy for proper appearance.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.8 out of 5 stars 41 reviews

What is wrong with my breasts?

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Thank you for your question and for providing the photos. While it is impossible to give specific advice without an actual exam, I can give you some thoughts based on the photos.

Looking at your photos, It does not appear that you have a capsular contracture. It looks more like your implants remained in an overly high position without dropping the expected amount. It also looks like you have some sag of your breasts that are compounding the issue. This could be corrected by dropping the implants a bit and doing a lift. It does not look like lowering the implants alone would be sufficient to correct your breasts.

I would suggest discussing your breasts with your plastic surgeon. Ask about a specific plan and what the ultimate expected outcome should be. In the end, you should be able to have your breasts look the way that you desire.

Best of luck with your breasts.

Jeff Rockmore

Is the Post-operative Problem Malposition, Capsular Contracture, or Something Else?

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    After surgery, the breast and implant and nipple position with respect to the implant are supposed to match. It is true that if the implant feels firm, is high on the chest wall, relatively immobile, these being the signs of capsular contracture, then that contracture can make the breast droop over the implant and the nipple appear too low.

    But if the implant is soft, relatively mobile, and seems to be sitting at the inframammary fold when you look and feel under the breast, then the implant is not the problem. The mismatch between the implant and the breast /skin envelope as shown in the photographs submitted is due to the excess of skin above the nipple that results in the nipple descending too low along the curve of the implant.

    Only an in-person exam could sort out these possibilities, but assuming no contracture is contributing to the appearance, and that the pre-operative evaluation showed that the nipple was lower than the level of the inframammary fold, then a lift might have been recommended at the time of the augmentation. The solution to the current appearance most likely requires a breast lift. 

    A breast lift involves removal of the extra skin above the areola, and moving the nipple/areola and breast skin envelope higher on the chest wall, tightening the skin around the implant and achieving a harmonious match between implant and breast.

   Not doing a lift when one is needed will result in this kind of appearance after an implant is placed. The breast simply slides down over the implant.

Robert M. Lowen, MD
Mountain View Plastic Surgeon
5.0 out of 5 stars 53 reviews

Breast Augmentation in Breasts that need Lift

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Dear Naweber,

The photos that you have provided are very helpful in evaluating your current frustrating condition.  However, they would be much helpful with pre operative photos as well.  The likelihood is that you really needed a breast lift along with your augmentation.  Oftentimes surgeons avoid performing the lift with the augmentation at the patients' requests to avoid scars.  No one, but you and your surgeon, know how the preoperative discussions went.  Regardless of what they were, the likelihood remains that you will need a lift.  Good luck!

Malposition? Capsular Contracture? Need Lift? What is Wrong with my Breasts?

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To be very honest you needed a lift plus a larger implant from the beginning. Best to obtain in person opinions 

Whats Wrong with My Breasts?

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Thank you for the good quality pictures and good description of your situation. Although your plastic surgeon is in the best position to advise you precisely, I think that is very likely that you are dealing with breast implants that are “riding high” in relation to breast tissue that is sitting relatively low on your chest wall.

 It is possible that capsulotomy surgery will be helpful in lowering the breast implant pockets;  some degree of breast lifting may also be very helpful.

 If you remain in doubt  after further discussion with your plastic surgeon, you may benefit from second opinion consultations.

 I hope this helps.

Breast lift needed

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Based on these photos, your areolas seem very low.  It looks like you need a breast lift, which is higher placement of your nipple.  You should keep up regularly with your PS if you think you have capsular contracture. 

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 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.