When a breast implant is placed the body attempts to wall it off forming a capsule around the implant. This capsule can be present within a week after surgery and is eventually present in all breasts containing implants. The end result look of a breast containing implants is due to:
  -the implant itself
  -the patient's breast tissue- skin, gland, fat,
  -nipple position on the chest wall
  -chest wall muscle and rib cage shape
  -the capsule formed around the implant.

The capsule can be of variable thickness and have different properties from patient to patient and even right breast vs. left breast. Thicker capsules or those that contain muscle cells can contract mishaping the breast and in some cases also cause pain - capsule contracture. It is not known exactly why some capsules become more problematic cosmetically speaking than others. It is thought that blood around the implant at the time of surgery or low grade infection early or late after surgery in is the culprit. Some capsules cause problems early after surgery and some take years to transform into a problematic capsule. In all cases of problematic capsules the naturally round contour of the breast is flattened in one or more areas including the upper portions of the breast. This can also occur if a breast implant breaks or ruptures.

Prior to the 1990s this was treated by squeezing the breasts hard enough to break the capsule - closed capsulotomy. This resulted in high recurrence rates because the capsule was not removed and high implant rupture rates. Currently the standard of care is surgical removal of all or most of the capsule - total or subtotal capsulectomy - and replacement of the implant(s). The goal is to allow the body to form a more favorable capsule and place a new breast implant that should last longer than the older one. There are no external balms, medications etc. that effectively treat capsular problems. In some cases capsule contracture especially if mild and shortly after surgery may be amenable to endermology. Interestingly, of all the non-plastic surgeons out there performing breast augmentation I've never heard of one of them willing to perform breast reconstruction or treat capsular problems.

In this case the patient had silicone gel implants placed over 15 years ago and more recently had an abdominoplasty by a non-plastic surgeon. The abdominoplasty was redone. The nipples were repositioned by performing a mastopexy, all of the capsule was removed - total capsulectomy - and new silicone gel implants placed above the muscle. Note the more rounded breast contour as a result of capsule removal. 50 years old, 5'6" tall, 116 lb., bra size 34D

Breast surgery can enhance your appearance and your self confidence. Realistic expectations are important to be happy with any surgery. As each patient is an individual, different results can be expected in each patient.