Ask. Dr. Barber

Q. I had a breast augmentation 9 years ago. I have silicone gel implants. One of my breasts is literally as hard as a rock and looks misshapen. I have not been back to a plastic surgeon because I had the surgery in another state. What is going on with this breast, and can it be fixed?

A. What you describe is a classic condition of a capsular contracture of the breast implant. This is a situation where the body reacts to the implant, which is a foreign body, by forming a thick, tight internal scar around the implant. This condition occurs more commonly in silicone gel implants (up to 15% risk) compared to saline implants (3%-5%). The theory on why this occurs is that the implant becomes contaminated with bacteria at the time of placement, likely due to the implant touching the skin during insertion. This bacterial contamination is minimal, and in fact, is not even enough bacteria to cause an infection. But, the small amount of bacteria that may have “hopped a ride with the implant” will cause inflammation which then stimulates the formation of scar tissue (the capsule). The medical term for this minimal bacterial contamination of an implant is a biofilm. As for treatment, the only way to remedy this situation is to remove the scar tissue (called a capsulectomy) and place a new implant. Unfortunately, there is no guarantee that the contracture will not come back again. I would urge you to see a board certified plastic surgeon about your situation. It can be made better for you.

Q. I had a breast augmentation last December. My right nipple area is completely numb. My left side is fairly normal. My surgeon said that the numbness will get better, but it has been four months and no change. What is your experience with loss of sensation in that area?

A. Numbness of the nipple-areolar area following breast augmentation is very common. I advise my patients that they can expect numbness that can last up to a year after surgery, although most of the time the sensation is back after a few months. The risk of permanent numbness is about 1%. If the sensation is not back by a year, the chance that it will come back is very low. Do not be concerned at this point since it has only been four months. The fact that one side is normal and the other side is numb is not uncommon. Be patient. Hopefully the sensitivity will begin to come back soon.

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