Swelling, hardening and pain in breast 5 months after breast augmentation. What could be the cause? My doctor isn't sure (Photo)

Capsular contractures can occur, but because of the circumferential 360 capsule squeezing in on itself, capsular contractures which can cause hardness and pain never cause enlargement because the word contracture means to pull in, not to push out.The symptoms you describe would seem to go along with a seroma or infection.  If you were my patient, I would make a small incision at the base of your inframammary fold after getting radiologic studies to show if fluid is present.  This drainage using a Seromacath with blunt tip would allow both in dwelling drainage and levage to occur, and also allow a culture and sensitivity to be sent to pathology.I recommend you follow your surgeon's instructions.

Dear 7296321,Thank you for your question. Capsular contracture does not occur overnight, it is a gradual process that occurs overs week to months. Other causes of swelling pain and warmth (fluid collection, infection) would be extremely rare and unlikely 5 months after surgery. In addition to the above, any change in implants so quickly would warrant an MRI in my opinion. That will tell you if you have fluid, or if there is rupture of the implant.Good luck,Nirmal R. Nathan, M.D.

Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgeons
Real Self Hall of Fame

Hello,
Thank you for your question. It is extremely unusual to have infection this far out from operation. Most likely cause is capsular contracture which is early but could happen. I recommend to follow with your plastic surgeon closely. If the size of your right breast keep increasing then you might need a radiological study to evaluate the pocket and implants. Good Luck!

Dear 7296321,
based on your description and symptoms, there is a chance that you have capsular contracture. 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 
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Hello! Thank you for your question. Capsular contractures don't suddenly appear overnight. (Though it is possible that the process was more gradual, and you only recently noticed the change.) Sudden swelling several months after the original procedure could be caused by a fluid collection or an infection. You should follow up closely with your plastic surgeon until you identify the cause of your condition and develop a plan of care. Best of luck!
Matthew A. DelMauro, M.D.

If so, you have to have some kind of fluid collection.  The other symptoms all go with contracture, even if somewhat early in the healing process.  If this happened overnight and acutely, it is not a contracture.  You could have an ultrasound to see if its fluid or not and that doesn't cost much in relative terms.  If fluid is present, a blunt cannula can be placed in a stair-step manner to access the pocket (at some risk of injuring the implant) so fluid can be collected for cultures and analysis.  If no fluid, treating as if infected is a reasonable path of management.  Your surgeon will eventually figure this out for you.

Your photo and description indicates that you may have a capsular contraction.  They are uncommon this close to surgery, but not impossible.  Continue to follow the advice of your plastic surgeon to determine the best course of action for you.

Thank you for your question. I am sorry you are having issues with your implants. Your description points to capsular contracture. I think your PS is doing everything. Sometimes we may not know the cause. 

capsular contracture, ask you doctor for start Medical treatment and followup or consider change the implant 

Hi
and welcome to our forum!
From your history, your symptoms are compatible with capsular contracture, as the breast has become firm, tender, and has elevated on the chest wall. Another possibility would be infection of the breast implant pocket although you would expect fever and redness of the breast. Although rare, a transient bacteremia caused by the brushing of teeth can be the cause. A late seroma is an unusual possibillity. An MRI may be of value in determining the cause.
Following
the procedure of saline or silicone augmentation mammoplasty, the surgical wounds
seal and undergo the healing process. This occurs in the underlying soft
tissues as well. The silicone polymer making up the shell of the breast implant
is biologically inert, and as such, the body creates a thin filmy internal scar
which surrounds the implant, holding it in its position. Thus, all breast
implant procedures involve the development of a thin capsule.  This
becomes problematic only if the scar shrinks substantially around the implant,
thus causing a capsular contracture. Manufacturer publications state that this
will occur in approximately 10% of all augmentation procedures.
Generally,
capsular contracture only needs to be addressed if the patient experiences
discomfort or if the implant becomes displaced, affecting the aesthetic outcome.
The
precise cause of capsular contracture is unknown but is unique amongst
individuals and their individual  immune response to the placement of a
foreign body. Its incidence is increased in the presence of
infection. Capsular contracture is not predictable nor a by-product of
surgical quality. It is highly recommended patients learn and follow a massage
routine that will dramatically reduce the incidence of contracture. While
postoperative massage will help prevent contracture, there exists the possibility
that the degree of contracture may require an outpatient procedure to remove
the scar tissue.
Maintain
close followup with your plastic surgeon.
Best
wishes...