Before and after bilateral breast revision in a 28-year-old woman. She had developed capsular contracture years after her past breast surgery – possibly due to a flare of acne and picking her pimples. Her right implant developed capsular contracture, causing it to sit up higher, feel hard and feel painful. By definition, this is classified as Grade IV capsular contracture.
Her left implant was “bottomed out” – meaning it sat lower than the natural inframammary fold. This was due to aggressive dissection of the pocket during her original surgery. The position of both implants in their too-high and too-low position accentuated the asymmetry.
Her revision involved bilateral capsulectomy and implant exchange. The left inframammary fold was reconstructed using suture techniques. A representative piece of scar tissue was sent to the Microbiology lab, looking for bacteria. A few colonies of Propionibacterium acnes were detected on the final culture results.
P. acnes is the bacteria that is associated with acne development and is a commensal organism that lives in our body and cannot be eradicated, but capsular contracture recurrence can be prevented with appropriate antibiotic treatment.
Our patient was put on an appropriate antibiotic for two weeks afterward that was tailored to the bacteria based on antibiotic sensitivity results. She began implant massage right away and promised to stop “picking her zits” and wash her face every night after wearing makeup every day.
Follow up photos are shown 3 months after surgery with greatly improved symmetry and two soft, mobile, natural looking breasts. Thankfully, capsular contracture did not recur, even decades later, and her left inframammary fold remained stable. She moved away to another state but follows up with us on video annually.
*All photos are actual patient photographs and are for illustrative purposes only. Individual results may vary.
