Breast Augmentation - Ask a Surgeon

Hard lumps following fat transfer can occur particularly when larger volumes of fat are transferred and not adequately dispersed throughout. Depending on how long ago your surgery was, you may have developed "fat necrosis" which is where the fat cells failed to "take" sufficiently and have now died. Your body naturally encloses this clump of cells and forms a firm nodule. Depending on the size, they may need to be surgically removed to fully address the firmness. Smaller nodules may be adequately addressed with steroid injections and massage. As always, any new lump in the breast should also be evaluated for malignancy, however, given your recent surgery this is not the likely culprit.

Capsular contracture may occur for various reasons such as sub-clinical bacterial contamination of the implant during placement, oversized implants for the breast pocket, genetic predisposition, and others. Overall, the rate of capsular contracture is approximately 1% per year. To minimize a patient's risk of developing capsular contracture, I recommend an inframammary incision (vs periareolar or axillary/armpit), submuscular implant placement, use of an implant funnel/no-touch technique, atraumatic technique, and aseptic pocket wash among other technical considerations. Once a contracture has developed, the best technique to reduce the risk of recurrence is to remove and replace the implant in a new plane.

Hey there.

Thank you so much for this question. Capsular contracture unfortunately is a known complication of breast implant surgery occurring 1% per year for a patient. In your case the risk would be 1%. Patient risk factors typically include any nicotine usage. The exact etiology is unknown but the most commonly accepted cause is bacterial colonization of the implant leading to the encapsulation. The most common treatment is implant exchange and 'pocket change'; meaning if you are on top of the muscle placing the implant below the muscle, or if you are below the muscle making a neosubpectoral pocket (new submuscular pocket). The site change is key as it helps to place the implant away from the presumed bacterial source.

In our practice we also are sure to copiously irrigate the pocket with several different antibacterial solutions to cleanse the area.

I would advise to make sure you are consulting with a board certified plastic surgeon who specializes in aesthetic surgery; a member of the Aesthetic Society illustrates this fact.

Thank you again for your question and best of luck.

Thank you so much for your question.

It is hard to determine what is occurring with the sound you are hearing. It may be a temporary issue or could be due to capsular contracture. The first thing I would have my patient is to have a mammogram/ultrasound to determine if the implant is intact without any signs of rupture or capsular contracture. I would also encourage you to schedule a consult with your board certified plastic surgeon to evaluate for any clinical signs of capsular contracture.

Thank you for your question and best of luck.