Muscle tightness vs capsular contracture?

Question

I've noticed since day one my left implant has riding a bit higher and hasn't completely dropped to-date, like my right one has. I had a bad feeling about this one from the beginning. The top feel tight, it's harder to sqeeze the implant and do my massages. When I lay on my stomach it feels like a ball, and is uncomfortable sleeping this way however no pain. They are still squishy standing up and don't appear to have cc. Im 3 months post-op. What's the different between cc and muscle tightness?

Gary Lawton, MD, FACS · Answer

At this point it is capsular contracture.Singulair may help, which can biological soften the
capsule. Sometimes in addition to the active massage of moving the breast in
the pocket (10 times per day one minute at a time), it helps to do some passive
massage.  Lie face down on a hard surface 20 minutes at a time 3 times per
day.  The weight of your body on your implants will passively stretch out
the capsule. Then you should also grab the implant from the top, and squeeze it
against the lower pole, holding steady pressure until your hand gets tired.
 Do this as often as you can in a day. This will stretch out the lower
pole.  So the combination of chemically softening the capsule (Singulair)
with the normal active massaging of the implant in every direction (10x per
day), passive massage (3x per day), and encouraging the implant down with
intermittent content pressure (as often as you can), you should a change in the
next several months.  I find no use for the bands. If this fails, you
should know by six months.  At that time a capsulectomy would be in order.Implant
massage is a critical part of the postoperative recovery from breast
augmentation (like physical therapy is a critical part of the postoperative
recovery from knee surgery).  The space for the implant is meticulously
crafted at the time of augmentation surgery, especially when the operation is
performed using the surgical endoscope through the transaxillary approach.
 However, the distance from the nipple to the inframammary fold needs to
stretch out to accommodate the implant (dropping) and the skin and muscle need
to relax to give the desired shape (fluffing).  Implant massage allows you
to manipulate the pocket from the inside to direct the forces in the
appropriate directions to mold the breast shape to the desired outcome.
 If the scar that is actively forming around the implant is allowed to
heal without the influence of breast massage, the fold will not stretch
appropriately (implant stays too high), the scar will attempt to contract in a
linear way over the curved surface of the implant (breast shape will remain too
flat), and the space will attempt to heal smaller and tighter than the implant
(capsular contracture).  Implant massage influences the scar formation on
the inside at the most critical phase of the healing, allowing the space to be larger
than the implant (mobility which creates the natural feel and bounce).

Implant
massage starts at one week at 5 times per day for one minute at a time and
continues at this pace until one month.  I often see the patients weekly
during this time to reinforce the technique and help the patients who need
extra effort to soften the breasts. During this time period, the massage also
breaks up the spasm, relieving the discomfort, particularly upon awakening from
sleep (morning breast).  During the day, every time there is the sensation
of tightness, implant massage breaks up the spasm and relieves the discomfort,
minimizing the need for narcotics.  At one month, the force that can be
exerted is increased but the frequency of massage decreases to 3 times per day.
 As the wound matures, the massage can decrease to once per day forever as
maintenance.  The patients integrate this into their shower routine.

Although
some patients can get away with no massage, it is a common issue for those who
stop the massage and make none of their follow up appointment to suddenly show
up years after surgery claiming that they woke up one morning with a capsular
contracture and implant malposition.  Of course this did not happen
overnight, but was a slow process that could have been prevented with daily
maintenance massage and regular routine follow appointments on a yearly basis
(which we provide for free, forever). With this type of perpetual follow up, it
is possible to identify a problem early that might need a modification in the
massage technique.

Implant
massage involves moving the device up against the wall of the pocket, holding
pressure against the surface of the scar. The specifics are determined on an
individual basis guided by what the patient needs. In some patients it is
simple and of little significance.  In some patients it is a struggle to
get the implants into the right position and to gain softness and mobility, but
with the right technique and the appropriate dedication it is a huge success.  For
the patients that do not participate in the massage in a meaningful way, some
will get away with their lack of dedication because they were going to have
soft breasts no matter what.  On the other hand, some patients will
squander their opportunity to have an excellent result because they don't
believe that the massage is necessary, or because they have been told by their
friends or other doctors that they didn't need to perform massage.
 Regardless, they often require surgery that could have been avoided by
following the postoperative instructions of a surgeon that has performed nearly
10,000 breast implant operations and has seen the healing of each of those
patients and integrated the successes and failures of each one into a
postoperative plan that really works.

I find no use for bands, straps, bras or appliances after
breast augmentation surgery.

Martin Jugenburg, MD · Answer

You are still very early in the post operative healing period. However, I reccommend you see your surgeon for an assessment. Regards,

Steven J. Rottman, MD, FACS · Answer

Thank you for your question.  You are still relatively early in the post-operative period, but it sounds like you have developed a capsular contracture.  I would suggest a trial of Singulair and massaging the implant multiple times per day. Please discuss your concerns with your board certified plastic surgeon. A Hope this helps and good luck with your recovery.

Jed H. Horowitz, MD, FACS · Answer

The final shape and size is approximated after 2 to 3 months, but up to one year may be required for the end result. Your doctor may require you to move or massage the implants within the breast pockets during the #postoperative period. However, #textured implants do not require breast massage. You will be informed about this at your post-operative visit. Also, the two breasts commonly heal quite differently so #assymetry is not unusual. One breast may swell more, feel more uncomfortable, or have a different initial shape. After complete #healing, they will be more similar and natural. Capsular Contraction is the #scar #tissue that forms around the implant as a natural response to a foreign object implanted in the body. The capsule can #tighten and squeeze the implant making it firm. This is referred to as capsular contracture. This firmness (breast capsule) can range from slight to very hard. The firmest ones can cause varying degrees of discomfort or pain. Capsular contracture can occur in one breast or both. Those  experiencing this are candidates for Breast Revision Surgery.  An implant revision or exchange intends to replace the damaged implants with new silicone or saline filled implants with newer technology.  econdary breast surgery can be complex and needs to be done by an experienced plastic surgeon. The specific procedure to be performed will depend on the complications experienced and the condition of the implants.For any concerns and questions about your #healing or #post-op, you should speak with your Board Certified Plastic Surgeon.

Muscle tightness vs capsular contracture?

Answers (4)

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