Swollen Breast 6 Years Post-op - Why?

From your description, I would agree with my colleagues who feel that the symptoms may be compatible with a capsular contracture. Meet with a plastic surgeon to confirm the diagnosis.

If you have one breast that is higher and fuller looking than the other side 6 years after surgery, you likely have a condition called capsular contracture. This basically means the implant has a shell of scar tissue around it which has become hardened over time and has distorted the shape and position of the implant.  The hard scar tissue also may have prevented the implant from settling down into a natural position as it did on the other side.

Please consult with a board certified plastic surgeon for an accurate diagnosis and treatment plan. You may require surgery to remove the scar tissue which will help restore better symmetry to your breasts.

Best wishes,

Dr. Bruno

You have capsular contracture of the breast.  This can be for one of several reasons:

1)hematoma or irritation around the implant from foreign material (talc, carbon, etc)

2)subclinical infection or colonization of the implant with bacteria

3)ruptured silicone implant (you probably have saline from 6 years ago)

4)idiopathic (which means we don't really know why)

Capsular contracture can be fixed with another surgery to release the capsule and correct the underlying problem.

It sounds like you have a breast that has a capsular contracture.  This is excessive scar tissue around a breast implant that can cause a change in breast shape and firmness. Sometimes pain is also involved.  I would advise you to revisit with your PS if possible or find a couple of board certified plastic surgeons to see for consult.

Dr. ES

Hi,

 

It's very possible you are developing a capsular contracture, or pathologic scar tissue build up around your breast implant. Common symptoms include a higher, firmer and rounder breast. The other possibility could be fluid build-up around the implant, either blood (hematoma) or inflammatory fluid (seroma).

Your best bet is an examination with a board-certified plastc surgeon to get answers. Best of luck.

When a breast implant is placed the body attempts to wall it off forming a capsule around the implant. This capsule can be present within a week after surgery & is eventually present in all breasts containing implants. The capsule can be of variable thickness & have different properties from patient to patient & even right breast vs. left breast. Thicker capsules can contract mishaping the breast & in some cases also cause pain. As the capsule contracts it squeezes the implant so that the implant appears to bulge outward and the edges of the implant move toward the center of the implant (that makes it look like it is higher up on the chest wall). It is not known exactly why some capsules become more problematic cosmetically speaking than others. It is thought that blood around the implant at the time of surgery or low grade infection early or late after surgery is the culprit. Some capsules cause problems early after surgery & some take years to transform into a problematic capsule. It's not known whether all capsules eventually become problematic but this is a distinct possibility.

The usual treatment is removal of the capsule and implant and placement of a new implant.

You could have scar tissue around the implant (capsular contracture) which can make the breast look higher or more projecting with associated firmness. A fluid collection ( seroma ) is another possibility. I would recommend an exam by your plastic surgeon to clarify your diagnosis.

Please see a plastic surgeon to evaluate your situation, there could be a number of different scenarios to account for this and the only way to adequately diagnose it, is to be seen and examined.  If it is just capsular contracture, start on Vitamin E, 2,000 International Units/day for 3 months.  This is very safe and may help to soften your implant.

A swollen breast six years after augmenatation can be several things including a dormant infection, a capsular contracture to name a few.  You should get examined.

Regarding: "Swollen Breast 6 Years Post-op - Why?
I have one swollen breast that is higher and more full looking than the other. I had breast augmentation done 6 years ago. There is no pain. I had started to work out again a couple of days before I noticed the difference but there is no pain in the area. Any idea of what could be causing this?"

I agree with my colleagues. The most likely explanation is excessive scar formation, Capsular Contracture, around the higher, fuller looking breast. While every single implant (such as joints, pacemakers, artificial vessels or shunts) are walled off with think scar tissue by the body, occasionally the scar tissue is exaggerated and a contracture forms. While there are many potential causes proposed for contractures seen shortly after surgery, the most common potential cause for a delayed contracture is infection elsewhere in the body which allowed bacteria to travel through the blood stream (bacteremia) and seed the implant triggering this reaction.

Capsular Contractures rarely if ever improve by themselves but many have tried using Vitamin E and other preparations with mixed success. The accepted treatment is either partial or nearly complete removal of the scar tissue with the implants (Capsulectomy). The recurrence rate is high. But there is increasing evidence that placing an acellular dermal matrix (ADM) such as Strattice (a pig skin derived product) at the same time the new implants are placed interrupts the re-scarring process and greatly reduces recurrences. Strattice is expensive but is cheaper than having a third or fourth operation.

Consult with your Plastic surgeon and learn all your options.

Dr. Peter Aldea