Does anyone think I might have capsular contracture? I’m 10 months post op 605cc silicone soft (Photo)

Question

My surgeon told me he didn’t think I needed a lift but I believe I did. I don’t have much cleavage at all. Anyone suggestions as to what could fix this problem. I wanted lots of cleavage

Semih Yildiz, MD, FEPOBRAS · Answer

Based on the photos, your implants appear large with a relatively wide natural space between the breasts and limited medial cleavage. I do not see an obvious photo-only sign of severe capsular contracture, but capsular contracture cannot be diagnosed from photos alone. It depends on how the breast feels, whether the implant is firm or painful, how mobile it is, and whether there is progressive shape distortion or a high-riding implant on exam.

A breast lift and cleavage are also separate issues. A lift can raise the nipple and tighten/reshape loose skin, but it does not reliably move the breasts closer together. Cleavage is strongly influenced by your chest width, breast footprint, implant pocket position, soft-tissue thickness, implant profile, and how close the surgeon can safely make the pockets. If the pockets are made too close in an attempt to force cleavage, it can increase the risk of implant malposition or symmastia.

At 10 months, much of the settling has already occurred, although subtle changes can still happen. If the breast feels soft and the implant moves normally, the concern may be more about implant position, pocket dimensions, breast anatomy, or expectation mismatch rather than capsular contracture. If the breast is hard, painful, unusually round, high, or becoming more distorted, then capsular contracture should be evaluated in person.

The best next step is an in-person exam with your surgeon or a second board-certified plastic surgeon. Possible revision options, depending on the exam, may include pocket adjustment, implant exchange, selective internal support, fat grafting for modest medial/upper-pole blending, or a lift if nipple position and loose skin are truly part of the problem. I would be cautious about any plan promising dramatic cleavage, because the safest and most natural result still has to respect your anatomy.

Daniel Butz, MD · Answer

It's hard to fully evaluate CC based on your photos alone. Are they firm? Painful? Did they start lower and migrate up higher?
You likely could've benefited from a mastopexy - that won't improve the cleavage though - just change the nipple position that is a touch too lower.

I would argue you have you quite a bit of cleavage. You have fairly large implants and they're practically touching without a bra. You could always get a 2nd in person opinion to properly assess for CC but it's likely just residue skin laxity causing the nipple drooping.

Gianfranco Frojo, MD · Answer

I would recommend a lift.  I would recommend finding a surgeon certified by the American Board of Plastic Surgery with experience in complex breast issues. This surgeon ideally has also completed a fellowship accredited by the Aesthetic Society.

Eric Swanson, MD · Answer

Your right implant is definitely sitting high. Is it firm? If the breast gets firmer and the implant displaces up, that is a capsular contracture. The alternative is just an implant that is sitting high and has not dropped. It has been 10 months, so I would expect your implant to drop by now. Usually you need a bra to show a deep cleavage because breasts tend to separate without one. You are in a gray area regarding a lift. If you want your breasts lifted (such as by lifting them with the cups of your hands) and if you want your nipples situated higher, then there is really no choice. The best type of lift is a vertical lift. I use a medial pedicle. The inverted T "anchor scar" method is obsolete, in my opinion.

Daniel Barrett, MD · Answer

Dear Forceful967461,
capsular contracture happens. In fact, every implant has a capsule form around it, its just a certain percentage develop thick capsules. There is a lot we don't know about it actually. Some think that bacteria that gets on the implant during insertion can increase the risk. Thats why we use a Keller Funnel in our practice to reduce that possibility. Our capsular contracture rate is less than 2% because we use a keller funnel as well as meticulous operating room techniques.I understand your concern. However, without a proper assessment, it would be difficult to determine what is wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Guler Gamze Eren, MD · Answer

Capsular contracture usually presents with pain and hardness of the breasts. Breast ultrasound can also help to show the thickness of the capsular tissue and it is usually possible to determine with physical examination. Your preoperative nipple position seems to be in a normal location. You should not forget that bigger implants may cause more sagging after breast augmentation surgery. I would recommend you a lifting surgery with a vertical or reverse T scar.

Brian K. Reedy, MD · Answer

Thanks for your question! I agree that you didn't need a lift in the initial surgery. I do think you may have CC on the one breast, but neither implant really dropped into place. I would suggest reaching out to your plastic surgeon to see what your options are. Good luck!

Stanley Castor, MD · Answer

If your breasts are soft and you don't have misshapen breasts, then you probably don't have capsular contracture. Capsular contracture will make the breasts much more firm with a squeezed appearance, so they look less round, but more oblong. As far as your cleavage, you have a full profile implant now. You would have to exchange them for an extra full profile implants and go larger. However, it looks like you have maxed out your implant size for now since your implants are almost touching together and your breast width of 14-15cm would not accommodate a larger implant at this time. I do agree you could have done a breast lift, but that is really personal preference. It appears you had a larger than average implant placed to get you more of a breast lift. I would recommend you follow up with your surgeon to discuss your concerns. Hope that helps!

Brian Widenhouse, MD · Answer

It appears from your photos that you would benefit from a lift, which may give you more cleavage.
A capsular contracture is not apparent from the photos; however, if your breasts feel hard or are painful, please see your plastic surgeon for further evaluation.
Best of luck!

Port City Plastic Surgery

Connie Hiers, MD, FACS · Answer

First, you need a lift. Second, your implants are much too large to fit your frame and tissue. They are not settling down because they cannot settle.  Please do not try to go bigger.

Does anyone think I might have capsular contracture? I’m 10 months post op 605cc silicone soft (Photo)

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