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

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.

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.

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.

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

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.

It is difficult to look at any post op hoot and recommend the exact surgical intervention that will make all right. A critical component to any revisionary consult would ideally involve your pre operative photos to evaluate any preexisting asymmetry. But that being said, it looksand sounds as though you have a capsular contracture of the left breast. It will require surgical intervention that would include complete removal of scar capsule and replacement of implants. I do not think you have bottomed out based on the photo provided. best of luck.

It is clear that there is asymmetry. The cause is not clear, and only with before photos and an in person exam are you likely to get a useful second opinion. The right side seems larger (hard to be sure with just one view), and seems also have more breast skin, which may have been the case before surgery (?). It sounds like your surgeon is proposing treating this as capsular contracture, and will use an acellular dermal matrix as part of the revision. This is all rather complex, and likely beyond what a surgeon would feel comfortable advising upon without more info.All the best.

Thank you for your question.Your right breast looks fine from the photograph.The current recommended treatment for capsular contraction is to remove the old implant, remove the capsule, place a new implant and cover the new implant with an acellular dermal matrix such as Flex HD, Strattice or AlloDerm.