Am I Suffering from Capsular Contracture, Can I Do Anything to Aide Healing, Will I Need Another Surgery? (photo)

7 weeks out from under the muscle, silicone implants. I had bleeding in my left breast the night of surgery, had 2nd surgery & a drain put in. That breast has healed perfectly. Dropped & softened within 3 weeks. Now my right breast is higher, its not really firm, I do feel a lot more hard knots/lumps including under the incision on right breast. I have a flat spot on the bottom of nipple along incision. When I flex it dents in. I am receiving ultrasound massage twice a week. I've done 3 so far.

Doctor Answers 20

Massage can helplower higher breast 7 weeks after breast augmentation

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Thank you for your question and photographs. At 7 weeks,,you state that the higher breast is not firm which implies that a significant capsular contraction has not occurred. Ask your plastic surgeon if you may do breast implant displacement exercises which may help lower the higher implant.

The retraction of your incision with muscle contraction is of concern. Again massage and the ultrasound treatments that you are receiving may well help this. It sounds like your surgeon is concerned and involved in your care which is excellent. If the skin retraction does not resolve a simple revision may be possible after 6-12 months.

Breast augmentation issues

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The puckering may be from scar tissue that developed upon healing.  Sometimes massage helps sometimes time helps to soften it. As for a potential capsule, it is hard to say without can exam, but it is still early.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

May not be CC

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If your breasts have dropped a bit and aren't as firm, then you may not be experiencing capsular contracture. I suggest you see your surgeon, however, just to make sure. 

Capsular Contracture or Skin Tethering at Incision Site

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It is hard to say without an exam whether you have capsular contracture or just superficial scar tissue tethering the skin to the underlying muscle.    Capsular Contracture is one of the main risks of breast augmentation.   Classic signs are:

1.  hardness/tightness of the implant
2.  change in implant position (typically migrates towards the collarbone)
3.  increased pain and stiffness on the associated side.
Based on your description, you should see a board certified plastic surgeon for evaluation of capsular contracture.    If present, I would recommend a capsulectomy (removal of scar tissue) and implant exchange. 
Factors to consider:
1.  If your implants are above your muscle, you may want to consider switching to underneath the muscle, which lessens the risk of capsular contracture.
2.  If your implants are above the muscle and you desire to keep them there, you may benefit from the use of a textured implant.
Dr. Gill

Paul S. Gill, MD
Houston Plastic Surgeon
4.8 out of 5 stars 94 reviews

Need an exam to know if you have a capsular contracture

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It is impossible to know if you have a capsular contracture without an examination.  You are still relatively early to develop this problem.  Your peri-areolar incision is adherent to the underlying capsule or muscle causing an indentation.  This will usually improve with time.  

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 20 reviews

Capsular Contracture and Breast Augmentation

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It is impossible to say whether this is an early capsular contracture without an examination but based on the photo it looks more like the sub-areolar scar has healed to the deep tissues. Massage usually helps this but if it does not resolve a minor procedure to free the scar tissue can help. The other issue is the fact that the right implant is higher than the left which may be caused by a higher inframammary fold on that side. Early-on it may settle with taping and massage but if it is late, using radial scoring or lowering the IMF on that side helps.

Misshapen breast after breast implant and capsular contracture

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Your posted photos show some asymmetry with the left implant and nipple slightly lower than the right. I believe this is an early capsular contracture. Your body formed more scar on the right and the scar between the skin and muscle is contiguous. If the massage does not work you will need revision surgery. Deep massage like endermology can work wonders in these situations. You are doing the right thing by continuing to follow up with your surgeon and he/she is doing the right thing by not being too aggressive too early. Surgery of any kind including revision surgery stimulates scar formation to some degree so it is better if you can get by without it.

I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles Plastic Surgeon

Capsular contracture after surgery

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You may need a revision procedure. I highly recommend you see your surgeon regarding the dimpling at areola.  

Revision after breast augmentation

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Aggressive massage and ultrasound may improve the dimpling at the areolar incision site but that area is notorious for retracting scars (due to scarred ducts).  It is also common for under-the-muscle implants to stay separated from native breast tissue (by the muscle layer) which can lead to a "double bubble" contour.  In this latter case a revision is needed to release the capsule to allow the implant to flow into the breast (instead of being isolated by the muscle layer).  Wait a full 3 months and see how things mature.

Am I Suffering from Capsular Contracture, Can I Do Anything to Aide Healing, Will I Need Another Surgery? (photo)

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Even with the posted photos it would be a guess if you need revisional surgery. But it is a real option after 3 months of healing. 

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.