Submit your question below about any cosmetic procedure to be considered for posting with an answer from one of our board-certified plastic surgeons.
Note: ASAPS cannot give advice about specific medical problems nor should answers provided by responding surgeons be substituted for a complete medical history, work-up and an in-personal medical/surgical consultation. Sorry we can't answer all questions. We try to select questions that have the widest general interest.
If you have had problems with Capsular Contracture, will the battle ever be won or should I give up on having nice breasts?
I had a Breast Augmentation in August. Three weeks later, because the implant wouldn't budge during massages, the one breast was opened back up. My Plastic Surgeon said that I had a significant amount of scar tissue, that he hadn't seen in previous years experience. Four months later, the same breast still has issues. It seems to be riding high. I can see my scar because it hasn't dropped. I know I have scar tissue pushing it up, because I can feel it. I also believe the implant is stuck to my chest wall now. When I lean over, the nipple area is loose vs the other breast that is full of implant. My Plastic Surgeon will not touch it until we reach the year mark. I've been massaging more than ever and feel I've gained nothing. Is there any hope for someone with multiple issues regarding scar tissue. I assume scar tissue is what is holding it to my chest wall due to the previous capsulectomy. Am I fighting a losing battle against my scar tissue or can this be beaten? Also, is there a difference between scar tissue and capsular contracture. My Plastic Surgeon has only called it scar tissue.
First, the capsule is a normal reaction to the implant. All implants have a capsule. The capsule is a scar.
It is VERY DIFFICULT to form Capsular Contracture in three weeks.
However, if there was some blood accumulation that was not recognized, one could form a hard scar. Capsular contracture occurs in 5-15%.
The other issue one needs to know is where the implant was placed - above or below the muscle?
It is possible if the implant is under the muscle that the muscle is not adequately released; this will cause the implant to ride high and be tight.
Have a second and a third opinion from a Board Certified Plastic Surgeon (American Board of Plastic Surgery). Also discuss this issue with your plastic surgeon.
It is unusual that a capsular contracture would occur within 3 weeks after surgery but it can be that an implant does not drop or settle as much as we would like. Capsular contracture is most certainly an occurrence (not really a complication) that plastic surgeons want to avoid. There are techniques that can be tried if a capsulectomy (removal of the capsule) does not work. Softer capsules may respond to non-surgical modalities such as Vitamin E, external ultrasound, massage, and in some cases off-label use of Singulair (an asthma medication). If surgery is attempted, the use of an acellular dermal matrix such as Strattice can be helpful in addition to removing part of all of the capsule.
I hope this helps.
I would recommend a second opinion with a board certified plastic surgeon. Look for someone who performs revision breast surgery often. Contracture of the capsule at 3 weeks seems a bit fast but not unheard of - vitamin E by mouth and other meds have showed some success. Ask your plastic surgeon for advice on alternatives. I agree that you should wait to have revision surgery until more inflammation goes away, but if you are in pain talk to your surgeon about having revision surgery sooner.
You should seek a second opinion with a board certified plastic surgeon who can evaluate you and discuss your concerns with you anew.
This may provide you with a new solution for your breast implant capsule contractures, or may reinforce what your original plastic surgeon has told you.
Sometimes removal of the implants without replacement, or removal of the breast implants with flap reconstruction might be considered. See nybreastreconstruction.com for more information about techniques including TRAM flaps, free TRAM flaps, and DIEP flaps.
Capsular contracture remains the most frustrating issue in breast implant surgery, for both surgeons and patients. In general, there are two categories of treatments for capsular contracture: non-surgical ones and surgical ones. Non-surgical treatments include massage, use of vitamin E, the use of off-label use of medications like Singulair, and external ultrasound.
Surgical treatments include: capsulectomy (remove the capsule layer) or capsulotomy (make cuts in the tight capsule, allowing it to expand), changing the location of the implant to a new plane, placement of materials called ADM's, or implant removal without replacement. Sometimes, implant removal is the best thing, although it's a difficult decision to face.
It's a complex topic, and your case is certainly complicated. I'd recommend a second opinion with an ASAPS surgeon that does a lot of revision breast surgery.
All the best,
It sounds like you have a Grade III capsular contracture. The "scar" your surgeon is referring to is probably the capsule, or lining of the breast implant pocket. Besides massage, you and your surgeon may want to consider the use of Accolate, to medically soften the capsule. If that combination doesn't work you would probably need a complete capsulectomy and implant re-positioning. Don't give up. You can still get a good result.
Don't give up hope! While none of us who haven't seen you personally can give specific advice, I would offer some encouragement that a good long-term solution is possible. If the implant never settled into the right position then it probably is not a typical capsular contracture. There are a number of effective options including the use of a Strattice graft but you would need to see someone who can determine what is best for your specific case. Waiting some months is good advice before re-operating.
It is possible that implants could be an option for you. it is also possible that you may need to go without implants for a period of time.
Another consideration for you might be breast augmentation using your own fat.
Situations like your do require patience and it can be frustrating. Hopefully you and your plastic surgeon can work together to discuss all possible options. Good luck.
Capsular contraction is in fact caused by scar tissue that tightens.
It is extremely rare to form a tight capsular contraction 3 weeks after breast augmentation. This raises the question as to whether your tight breast was due to an inadequate breast implant pocket during your first breast augmentation.
To answer your question there is hope to correct capsular contraction if you do in fact have one. Modern treatment of capsular contraction requires removal of the implant and capsular tissue, and insertion of a textured breast implant wrapped in a bio membrane called acellular dermis.
However I suggest that you seek consultation with another plastic surgeon to see if your problem is placement of the implant without an adequate sized pocket or in fact capsular contraction.