4 years post breast augmentation -- capsular contracture, bottoming out, both?

Question

I got a breast augmentation in October 2009. Within weeks of surgery, we noticed the left breast wasn't dropping, but I was assured that it would eventually. 4 years later, it's definitely got a tight contracture. A year ago, my PS told me that he suspected I also had bottomed out on the right side, and suggested I come back in for an internal bra, explant, and new implants inserted. I'm looking for a second opinion. If I were to have both removed and new implants put in, what would it entail?

Scott C. Sattler, MD, FACS · Answer

Based on a single photo, its impossible to say what is going on - but a familiar scenario is progressive capsular contracture of on one implant, which prevents its natural 'sag' and descent...coupled with normal sagging of an implant over time on the opposite side. bottoming out refers to the position of the implant relative to the infra-mammary fold, which can only be confirmed on exam.

Christopher J. Davidson, MD, FACS · Answer

I agree that you have a capsular contracture on the left and also that the right has some droop.  You are a candidate for a capsulectomy on the left.

Richard H. Tholen, MD, FACS · Answer

It's hard to make a definitive statement without the benefit of a personal examination, but based on your one photo alone, your right nipple areola position is as close to perfect as I can describe--NO "bottoming out." Your left breast does indeed look like a breast that has visibly-deforming (Baker 3-4) capsular contracture. Re-operation is the only way to deal with the left breast contracture, since you have long passed the potential for improvement via oral leukotriene inhibitor therapy. You will likely require complete capsulectomy and placement of a new implant. This is not just a "quick touch-up" surgery--it is a tedious, often-difficult procedure that doesn't always work. (It usually does, but avoidance of bacteria and bleeding is critical with this procedure.) This is why prevention is such a "big deal" in my practice, and we presently have about a 3% CC rate with primary (first-time) breast augmentation patients. Still, this means several CC patients every month or two, as I also see CC patients who had surgery elsewhere.Unless you want a different size or have any other issue with your right breast, I would not recommend operating on this side--you would surely regret doing this if you developed a problem where none previously existed!Since your surgeon seems to recommend operating on both breasts, I'd consider getting one or two additional opinions from experienced ABPS-certified plastic surgeons and see if they agree. Personal examination always trumps an on-line photo! Best wishes! Dr. Tholen

Asif Pirani, MD, FRCS(C) · Answer

I can't see any bottoming out in this photo.  You need to be examined in person to determine if you have a CC.  See a BC PS in your area.

Roger J. Friedman, MD · Answer

First, it is difficult to determine if there is bottoming out from a frontal view alone.  A side view would be helpful.  The nipple should be in the midpoint of the implant.  If this is not the case and you do not like the appearance than the right fold could be reset or possibly if the implant is under the muscle, a neosubpectoral dissection.On the left, I feel you would benefit by a capsulectomy, removing the entire capsule and   redefining the pocket and replacing the implant.

4 years post breast augmentation -- capsular contracture, bottoming out, both?

Answers (8)

Answer: BBA

Answer: BBA

Answer: Breast asymmetry

Answer: Breast asymmetry

Recommended reading

Everything you need to know about Capsular Contracture Treatment

Our mission is to create a world where every investment in modern beauty is Worth It.

4 years post breast augmentation -- capsular contracture, bottoming out, both?

Answers (8)

Answer: BBA

Answer: BBA

Answer: Breast asymmetry

Answer: Breast asymmetry

Browse related questions

Recommended reading

Everything you need to know about Capsular Contracture Treatment

Our mission is to create a world where every investment in modern beauty is Worth It.