Nipple Caved in After Explant. Due to Capsule Removal?

Question

I had my textured anatomical silicone implants (230cc, over the muscle) removed 5 months ago. I'd had the implants 11 years, over the muscle, and am now 30 years old. My surgeon removed 90% of the capsule even though it was thin, now half my nipple & areola is caved in on the right side, and appears to get pulled in when I tense my pecs. Could this be because she removed the capsule?

Richard J. Bruneteau, MD · Answer

It’s
not unusual for patients to experience breast distortion following removal of
ruptured silicone implants, especially when calcified capsular contractures are
present.  Under these circumstances
patients are often emotionally devastated by breast distortion and associated
loss of breast volume.

When
this situation arises in the immediate post-operative period, it can be
difficult to know if this distortion is permanent.  In some cases swelling resolves and tissue remodels over the
course of 3-6 months with significant improvement in the aesthetic result.  In other cases, the deformity may be
permanent and secondary surgery may be indicated.  This may include implant replacement, breast lift and
possibly fat grafting procedures.

In
your case it appears that the under surface of the nipple areola complex has
adhered to the underlying muscle. 
When the muscle contracts the nipple areola is pulled in an inward
direction.  When the capsule is
totally removed at the time of implant removal, raw surfaces are created within
the breast pocket.  When opposing surfaces
within the pocket heal together in the presence of thin overlying soft tissue,
distortion of the soft tissue can occur with muscular contracture.

In
some cases massage may correct this problem, but in the vast majority of cases
surgical release of the scar contracture will be necessary.  In some cases interposition of soft
tissue may be necessary to recreate the normal soft tissue glide that occurs in
this area.

If
you’re concerned about the appearance of your breasts following implant
removal, consultation with a board certified plastic
surgeon is appropriate.  This surgeon
should be able to formulate an appropriate treatment plan.

Jed H. Horowitz, MD, FACS · Answer

Good day! Nipple inversion may occur after trauma and can be corrected with a procedure performed in the office under local anesthesia which is commonly performed with breast revision surgery. In severe cases of nipple inversion the breast ducts may need to be severed. For others, devices such as the Niplette by Advent can be used without surgery with some success. It is often used after surgery to create suction and maintain the correction.
Do not hesitate to ask your doctor or find a board-certified surgeon that has extensive experience with this procedure. Best of luck! #RealSelf100

Jeffrey E. Schreiber, MD, FACS · Answer

It's most likely the cause, but it's hard to give you an exact answer without seeing you.  You'll probably need new implants and/or a lift to correct the problem.

Otto Joseph Placik, MD · Answer

Nipple retraction is not uncommon in the post-operative period due to scar tethering of the nipple ducts. Gently massage and stretching of the nipples will help. Occasionally a device called the Nipplette is useful for this purpose as well. It should generally resolve by 6-9 months. IF if persists beyond this, release of the ducts may be required

Camille Cash, MD · Answer

After having your implants in place for eleven years your skin stretched to accommodate the implant.  When that volume was removed you likely had some skin retraction, but still have some laxity.  You can elect to have the look corrected by your surgeon.  A small amount of fat grafting or a lift can be done to improve overall shape.

Tom J. Pousti, MD · Answer

Thank you for the question and picture.

	Unfortunately,  what you are experiencing can occur after breast implant removal.  This  concavity/inversion can occur with or without capsulectomy having been performed. I woild suggest massage of the area.  This may improve with time.

	This wishes.

Byron D. Poindexter, MD · Answer

Most likely this is from internal scar formation as well as deflation of the tissues after implant removal. There may be a "tether" of scar from the nipple to the muscle.  As others have suggested fat grafting may improve this. It is possible to get similar issues with less capsule removal but probably not as likely.

	Continue to follow closely with your surgeon during the healing as the scar tissue continues to relax, and don't forget to get a mammogram before doing any fat grafting to the area.  Breast cancer can cause some changes around the nipple and while rare in a 30 year old better safe than sorry.  We also do not have long term data on the fat grafting.

Steven Wallach, MD · Answer

The nipple and skin retraction could be from removal of the capsule or could jsut be from scar tissue developing between the tissues that have sealed up. Sometimes this can be corrected with fat grafts or even alloderm.

James Apesos, MD · Answer

Since the nipples retract with your muscle movement it means that scar tissue is pulling the nipple when the muscle twitches. I find that leaving more capsule in place couild circumvent that from happening. The nexte step may be a fat injection to gill in the area. Very new (experimental?) but many be the answer.

Peter A. Aldea, MD · Answer

Regarding: "Nipple Caved in After Explant. Due to Capsule Removal?
	
	I had my textured anatomical silicone implants (230cc, over the muscle) removed 5 months ago. I'd had the implants 11 years, over the muscle, and am now 30 years old. My surgeon removed 90% of the capsule even though it was thin, now half my nipple & areola is caved in on the right side, and appears to get pulled in when I tense my pecs. Could this be because she removed the capsule?"

	Your breasts appear deflated, more on the right than on the left side. I think the reason for the tethering of the right nipple complex which gets worse when you flex the muscle is that a scar formed between the underneath of the nipple complex and the muscle. Each time the muscle contracts it pulls on the scar leading to further depression of the nipple complex. This can probably corrected with an office procedure in which the scar is undermined and divided and a wrinkle filler is injected in the divided scar to prevent its reattaching.

	Dr. Peter Aldea

Nipple Caved in After Explant. Due to Capsule Removal?

Answers (11)

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