1 Year Post Breast Implants: Worried I Have Capsular Contracture

A year ago next tuesday 5/10/2010,I had breast implant surgery, 36DD, saline implants, high profile, under the muscle(My left breast was always a half cup size smaller than my right) My fourth visit after surgery,I mentioned to my PS my left breast implant felt lower than my right, he imformed me to keep massaging and everything should fall into place.

Last month or so I noticed my left breast was tender under neath, feels slightly tight and looks as if its sitting higher than my right. Worried!!

Doctor Answers 15

Possible capsular contracture 1 year post-op?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

At one year post-op, your description is accurate for capsular contracture. Since bleeding and bacteria are the two most common causes of (late) capsular contracture, do you remember any moderate trauma to your left breast at about the time of the tightness, tenderness, and switch from sitting lower to higher than the opposite breast? If so, you might have had some bleeding, which now has developed into the tight, firm, sore capsular contracture. The other cause would be bacteria--can you specifically recall an incident where you may have been ill enough to have bacteria in your blood stream at the same time as a minor bump or bruise to the breast that could allow the bacteremia to enter the space around your implant and stimulate the capsular contracture? The most common scenario where this can occur is with dental work, including cleaning. I have seen several cases of dental work-induced capsular contracture (late, unilateral, 1-3 weeks after dental work). Though I am in a minority of plastic surgeons who do this, we believe that antibiotic prophylaxis prior to dental work is appropriate to minimize the risk of developing capsular contracture from dental work.

Regardless of the cause, it appears as if you do really have capsular contracture, and may well require surgical intervention. If you capsule is early and relatively mild, a course of Singulair or Accolate and Vitamin E may reduce the severity of the capsule enough to avoid surgery, but I have seen this work in only a few cases. Still, if your capsule is mild and early, this may be worth a try!

Otherwise, you will require surgical capsulotomy, capsulectomy, and possibly new implant(s). Certainly the size of your implants leave little room for contracture, but unless you really feel too large, I have to assume that until this left-sided contracture developed, you were happy with your size. Smaller implants in the present pockets may be an "easy" fix, but may not be the best surgical choice. Rely on your surgeon's advice, as you will be returning to him or her if the capsular contracture worsens or recurs.

1 breast implant higher and tighter one year after breast augmentation may be capsular contraction

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Thank you for your question and photographs. The symptoms that you describe, with 1 breast implant feeling firmer and looking higher could suggest a capsular contraction. Be sure to see your plastic surgeon

Capsular contracture.

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Given the history you've provided and the photos, I would agree that you probably have a capsular contracture of the left breast. That being said, your implants are high in both breasts as seen on the profile picture. The silhouette of the right breast shows a tight lower pole of that breast as well. I recommend a follow up examination with your plastic surgeon to evaluate your options. This may include a revision of both breasts to improve the implant placement as well as correct any capsular contracture.

David Bogue, MD
Boca Raton Plastic Surgeon
5.0 out of 5 stars 26 reviews

Best to be Evaluated in Person to Determine Capsular Contracture

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

I suggest beginning with an in-person #evaluation with your original surgeon, or, one who is board certified. It is best select a plastic surgeon who is #board-certified and has a great deal of experience with breast #augmentation and the incision type, #implant placement, and implant type.

One of the most common problems is breast capsular #contracture or the development of thickening, and contracture of the capsule that exists around the breast implants. Severe capsule contracture probably occurs in less than 15% of augmentation patients. Every woman has a breast capsule around their implant and this is a normal phenomenon. The capsule itself could be as thin as Saran Wrap but may also become calcified and thickened. As it thickens and shrinks, the patient may develop a feeling a firmness of the breasts and in its worst situation, the breast may become painful and abnormal in appearance, achieving a very round, hard, and uneven appearance. There may be distortion and possible breakage and leakage of an older implant, but may also include a newer #implant. Nicotine users, such as smokers, have up to a 30x increased risk of #capsular contracture. An in-person examination will better determine if in fact, this is the case. 

Possible Capsular Contracture

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Capsular contracture is when there is abnormal scarring around your implant, tightening it and causing the breast to feel firm. The breast may also look abnormally round or elevated. This can sometimes be treated without surgery, but if the problem persists, you may need surgery. I recommend you go back to your surgeon to have your breast checked out as soon as you can. Best of luck.

1 year post-breast implants - worried I have capsular contracture.

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Hello! Thank you for your question! Physical examination will determine if you have capsular contracture. The look and feel of hardness surrounding your implant is seen and/or felt. At its worst, you experience pain. It may also cause distortion of your breast. What has caused it will be in question.  Your description and photos sound. consistent with capsular contracture. 

Your surgeon will likely recommend implant massage and may add the medication Singulair. If these fail, surgical correction may be suggested. It is a matter of surgeon preference as well as what is seen during your procedure that will determine whether or not a complete capsulectomy is performed. If significant capsule formation is seen intraoperatively, a full capule removal may be warranted with a drain in order to completely remove all of the tissue and allow better adherence of your breast back to its normal anatomic position down on your chest wall. Irrigating with certain medications may also be if benefit. If minimal contracture is seen, it may be possible to leave the capsule, or place cuts within the capsule to allow better adherence. It truly is dependent on what is seen with your capsule and the issues that may be causing you to have such a procedure (e.g., contracture from rutptured implant vs pain vs simple pocket adjustment, etc).

Without knowing your issues and without an examination, it is difficult to tell you what may be the best thing for you. I tend to favor performing capsulectomies in order to create a fresh pocket, reshape the pocket, allow better shape and adherence of the overlying breast. I would discuss your issues with your plastic surgeon who will assist you in determining the right modality for you. Hope that this helps! Best wishes!

Signs of Capsular Contracture

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Thank you for your question.  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

Capsule contracture

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

 Your photos suggest that you have a capsule contractue on the left side causing the implant to sit high .

There are lots of reasons for capsule contracture and it may have been coming on for some time.

It looks unlikely that massage alone will resolve the contracture that you have, You will most likely reqiure revision surgery.

When you see your surgeon please make sure that you discuss yuor options in particular the size of your implants the possible recurrence rate of capsule contracture.

Isolde Hertess, MD
Gold Coast Plastic Surgeon

High Riding Implant, Capsular Contracture?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

The patient illustrated in this picture is presenting high riding implant on the left side. There are multiple reasons for that; these implants can be too big for her to start with and also it may be a high riding implant or it may be a capsular contracture or both. Whatever the problem may be it can not be fixed by just massaging the implants, this patient will require some kind of revision surgery. During the revision, it is highly recommended that these implants be changed for a smaller size.

Another vote for revision of augmentation with smaller implants

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

its hard to tell without a hands-on exam exactly what factor(s) are causing the appearance here, but clearly a revisional procedure will likely need to be considered.... and i would strongly recommend that this time smaller (and perhaps lower profile) implants be part of the "fix".

Bruce K. Barach, MD
Schenectady Plastic Surgeon
4.6 out of 5 stars 13 reviews

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.