How do you know if you have capsular contraction?

I'm 9 months post-op for submuscular saline breast implants, and I have been recently experiencing pain on the right side. Both breasts look natural, as expected but the right side is a little more firm to the touch. I will add that I am right handed and sleep on the right side more so than the left.

How do I know if I'm developing capsular contraction on the right side without contacting my PS? I have been to all my post-op appointments and got the good bill of health from him. I was instructed to call the office for any issues but am I overreacting. Is this pain normal? Please help!



F, 34, Delaware

3 weeks is way too soon to be judging results in something like this. Give yourself 3 months and see how the breasts look and feel then. A lot of changes occur in those first 3 months. And, yes, a pocket can be too small. 

Capsular contracture is pretty simple to assess. If your breast(s) feels firmer than normal, you probably have an element of capsular contracture. Contracture is gauged on a simple 1 to 4 scale. A 1 is a soft, natural breast. A 2 is firmer than normal but retains a nice contour. A 3 is firmer still but now the breast contour is altered. It may be too round, the implant may sit too high, and/or the breasts may be too far apart. A 4 is what I call the "billiard ball", a hard, misshapen, uncomfortable breast. The scale is useful but not perfect; I have seen very hard breasts that looked OK. All patients and surgeons are happy with 1's and 2's. Many patients are OK with 3's. Nobody is happy with a 4 contracture. Contracture occurs because the scar that you form around the implant, the capsule, can gradually tighten around the implant over time, squeezing it, and making the breast feel too firm. We do not understand why this occurs in some patients and do not have a universally effective way to prevent it. The incidence ranges from 3% to 15% of women with implants. Firmness usually develops in the first few months after surgery but can occur years later. The only corrective measure is to reoperate, which solves the problem, but it can recurr and some women seem prone to this. 

Pain after breast augmentation is a different issue and usually not related to contracture unless the contracture is severe. In the absence of infection, it is usually not serious and will respond to simple measures, such as a course of anti-inflammatory meds, or time. Talk to your surgeon about this. He or she should listen to you and either reassure you or offer some suggested steps. Sometimes, a degree of breast discomfort after surgery has to be accepted. Much depends on the circumstances. 

Sleep position is interesting. Studies have shown that sleep position can affect the final shape of the developing breast. It may have an effect on shape and implant position after breast augmentation as well.