I think I have capsular contracture 4 weeks post surgery? (Photos)

Question

I had breast Augmentation revision 4 weeks ago. From 420's to 550's. My right breast is smaller and feels tighter. I can't move with out feeling a sense of pulling. I started taking singular 11 days after surgery. What are my options? Will massage help?

Gerald Minniti, MD, FACS · Answer

Hello,
I am sorry, but sometimes we just don't give correct information. Here are some data that is closer to reality. Capsular contracture is the most common complication of breast augmentation, occurring (on average) 15% to 20% of the time within the first three years after surgery, most of which occurs with in the first three months. Early cc should be followed for at least 6 months as a small percentage can relax. Implant massage has been thoroughly debunked as ineffectual at preventing or treating capsular contracture. Surgeons like myself who stopped telling their patients to massage have not experienced an upswing in cc or any other healing problem.  In my case, I reduced my cc rate from 8% to 1%, due to other more important things that can minimize the risk of cc.  There is very good data that shows that Singulair and Accolate do not prevent or treat cc. There was one study that did not meet statistical significance that was published (unfortunately) about ten years ago that suggested that it diminished recurrent cc. This is most likely incorrect. If your revision surgery was through your nipples, you were placed at highest risk of cc with that choice.  CC is a problem associated with bacterial biofilm and that doesn't go away with antibiotics, Singulair, massage, vitamin E, NSAIDs, or ultrasound. My specialty is far behind others in getting the data out to it's members and applying the data to our day to day practice.  Many of my colleagues are still willing to do things based on myth and dogma rather than data proven evidence. Stop the meds and stop the massage.  Wait. If you get better, great. If not, find yourself a surgeon that performs the best revision surgery for cc, either a total en bloc capsulectomy or a total/subtotal capsulectomy with a biologic ADM.  Either surgery should be performed through an inframammary incision. Best of luck!

Luke J. Curtsinger, MD · Answer

It is difficult to say if you have CC based on the pictures.  Singular helps prevent capsular contracture, some of the time.  Massage can be useful with smooth round implants, but is not advised with shaped implants.  Ask your PS for massage instructions, if indicated.

Omar Lazos, MD · Answer

Greetings, at 1 month post-op is too early to mention if theres capsular contracture... actually the true capsule is forming ... This scenario is very common, both breast heal differently, and they settle at different rates. From a simple glance your breast look ok, just need some time to them to be in their final position, usually 3-6 months. Hopes this helps you on your concern, best regards !

Daniel Barrett, MD · Answer

Dear gabbymastro,Capsular contracture affects people approximately one in 20.  No one knows exactly what causes it and what can prevent it completely. It's important for your doctor to use a minimal incision and a Keller funnel as a sleeve to protect the implant from touching anything before goes into the breast pocket.  Singulair has been shown to prevent it so you're doing the right thing there. I would suggest you to consult your plastic surgeon. You will get the best recommendations after a thorough examination.Daniel Barrett, MD, MHA, MS 
Certified, American Board of Plastic Surgery  
Member, Am. Society of Plastic Surgery

Leo Lapuerta, MD · Answer

Thank you for sharing your photos.  It is difficult to see with the photos if you indeed have a capsular contracture.  The best thing is to follow up with your physician.  If your doctor gave you the singular then there is a possibility that they are trying to stop it from happening.  Continue to stay in contact with your physician.  Best of luck to you !

Tim Sayed, MD, MBA, FACS · Answer

Hard to tell from your generally good results whether you have capsular contracture, but the symptoms may be suggestive. Singulair is off-label from the FDA standpoint so I would make sure this is under proper physician surveillance as there are rare but serious potential side effects. There is some data to support its use early in capsular contracture but I don't believe anecdotally that most plastic surgeons find it makes a big difference to established cap-con. Best to be checking in for regular exams with your surgeon. Capsular massage is also somewhat controversial though overwhelmingly more commonly recommended by plastic surgeons - we just don't have great data to say it really makes a difference to the pockets/capsules, but it probably does not hurt in the vast majority of patients who apply capsule massage postop. Ultrasound-assisted capsular massage, such as that obtained at Aspen Rehab and similar facilities, may be beneficial in some patients under physician orders.

Camille Cash, MD · Answer

The tightness and pulling sensation you described can be part of the normal healing process.  Massaging the breast may help.  It is best to contact your surgeon regarding your concerns.  A quick exam should help yield the answers.

Chad Robbins, MD · Answer

Thank you for your question and photo's .  Without seeing you in person , it's difficult to know if you have cc.  I don't see that your right breast is smaller from looking at the photo's, it may still be early to know , however, your PS will examine them and let you know if it's cc or just the fact that it's early and you still feel discomfort at this time.

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