How can one avoid capsular contracture after a breast implant?

Some surgeons usually insert a breast implant with a smooth texture to avoid this complication, or the implant can be placed underneath the muscles. Neither is foolproof and there is no guarantee against development of contracture.

I have recently had breast implants and have heard that the capsule contracture can occur in future. Is there any way of knowing when this will occur?

Capsule contracture is a common complication and over time at least 10-30% of women develop the condition. Anecdotal reports indicate that capsular contraction can present anytime after the third year of breast implant. Capsular contraction is simply excess scar formation around the capsule of the implant. The scar becomes thick and hard. The female will complain of intermittent pain and altered texture of the skin. Distortion of breast tissue is sometimes visible. When the pain is excessive, surgical removal of scar tissue is required. In the unfortunate female with recurrent capsular contractures, the implant has to be permanently removed. It is hard to predict who will develop capsular contracture. MRI can identify the problem.

My surgeon is insisting that I have breast reduction surgery. I am puzzled by the rush. Do you have any thoughts?

Dump the bum. All women should understand that breast reduction is an elective procedure and therefore, should not be rushed. Before you undergo this surgery, find about more about the procedure and the surgeon. Ask where you will undergo the surgery and who will give you anesthesia. Breast reduction may require an overnight stay in a hospital.  Finally, get the costs. There are many excellent surgeons who regularly perform breast reduction surgery and so the onus is on to you to ask questions; but if you are ever in doubt get a second opinion.

I am 19 years old and am thinking about a breast reduction. Do you think this is okay?

Breast reduction should not be done before the age of 20-22 because the breasts are still growing. The surgery for breast reduction is best done when the breasts have reached their maximum growth at around the age of 25. In very rare cases, breast reductions are done in school-aged females who encounter humiliation and stress from their colleagues because of large breasts. Another common reason to delay breast reduction is soon after pregnancy. The breast swelling that occurs during pregnancy often subsides within 3-6 months. Pregnancy can also lead to changes in the shape, size, texture, contour and cause sagginess of the breasts. It is better to complete all child bearing before one decides to undergo breast reduction. After breast reduction, you do need at least 4-6 weeks to fully recover.

Besides cosmesis, are there any other reasons why women undergo breast reduction surgery?

Each year approximately 100,000 women undergo breast reduction procedures due to large uncomfortable breasts. Besides poor cosmesis, women with large breasts also suffer from several health problems like 1) neck and back pain 2) pain along the bra straps 3) deep grooves from bra straps 4) poor slouching posture 5) recurrent skin infections or rashes along the breast creases 6) low self esteem, 7) isolation and depression and 8) having difficulty finding proper sized clothes.

I am a 26 year old female with large breasts and do not feel sexy at all. In fact I am embarrassed and feel like undergoing breast reduction surgery. Should I go for it?

Many women seek breast reduction surgery for large breasts. It is a myth that having large breasts is always associated with feeling sexy. In fact some women feel ridiculed or embarrassed as being regarded as "sex objects " or "easy" simply because they have large breasts. However, just like breast augmentation, the results after breast reduction depend a lot on the experience of your surgeon. Breast reduction is a delicate art and generally produces excellent cosmetic results (unless you pick a bad surgeon-and there are plenty of those around).

My doctor says he will perform a breast biopsy using MRI. Is this really necessary?

In some women, the mass may be very small and difficult to easily access blindly. Thus, an MRI breast biopsy may be required.  MRI is a very sophisticated radiological imaging device that can identify very small breast lesions. Prior to the procedure, you will be asked to like down on a flat table and an MRI of the breasts is obtained. Once the lesion has been documented, it is mapped out and marked. A small needle is inserted into the mass and a biopsy is performed. This procedure does not take more than 20-30 minutes, is not painful but MRI is expensive. Perhaps you should ask your doctor why he cant do the biopsy using ultrasound. Doctors do tend to order expensive tests, especially when you have great insurance!

My doctor inserted a needle in my breast and was not able to get any sample. Now he says I need a proper biopsy. Is he for real?

Sometimes the doctor is not able to get enough tissue samples using a needle biopsy and thus another biopsy technique is required. A breast core biopsy procedure utilizes a large size needle to biopsy the mass. In addition, the procedure is done in the presence of an ultrasound or mammogram so that the needle can be guided to the core of the breast mass. Core biopsy of the breast is done as an outpatient procedure. At the radiology clinic, you will be asked to lie down on a table. Images of the breast are obtained with a mammogram or ultrasound and then the needle is carefully guided to the center of the mass. This method ensures that the sample will be obtained directly from the abnormal area of the breast. Unlike the needle biopsy, breast core biopsy do have a tendency to cause bleeding, bruising and mild pain.

How is a needle biopsy done?

A breast needle biopsy is done in a doctor’s office. The doctor usually cleans the skin overlying the breast and may also numb the area with a local anesthetic.  A small needle is then placed into the breast mass and the contents are aspirated. All women should understand that with a breast needle biopsy there are only a few cells obtained. The cells are smeared onto a slide, which is then sent to the pathologist to determine if they look abnormal.

I am 43 years old and have a 1 cm left breast mass. My doctor says I need a needle biopsy. Is this necessary?

Women who have a mass often need to undergo a breast biopsy. There are many types of breast biopsy procedures for women who have a breast mass.  It is impossible to tell if a mass is a cancer just by examining the breast with the hands. The only definitive way to confirm a cancer is to perform a breast biopsy and send the tissue to the pathologist for examination. In your case, a needle biopsy is fine.

I am 44 years old and have a 4 cm right breast mass. My doctor says I need a surgical biopsy. Is this really necessary

Some patients with a large breast mass may need to undergo an open surgical biopsy. Surgical biopsy of the breast may be performed under local or general anesthesia. Surgery requires a small incision and a biopsy can be easily obtained. In the past most breast biopsies were performed using surgery but today the development of ultrasound and MRI has led to demise of surgery to obtain biopsies. Perhaps you can ask your doctor about a needle biopsy first. 

It is highly recommended that any women with an unknown breast mass undergo some type of breast biopsy procedure to confirm the identity of the lesion.

I am a 35 year old female and often find that the chest wall and ribs surrounding my breast are sore. What do you think is going on?

Some women tend to develop breast swelling tenderness that is not cyclical. The pain in the breast is often localized to one area and may have occurred from trauma, infection or from a large cyst. Often this type of pain is worsened in women who take supplementary hormones. Other causes of breast pain may be related to the chest wall and ribs. Some young women often develop intense pain that is felt when the bony surface of the chest is touched- this is referred to as costochondritis. This type of pain has no cyclical pattern, often worsens with a deep breath and in most cases spontaneously disappears.

I am a 29 year old female who develop breast pain just before the beginning of my menstrual cycle. Is this normal?

In some women, the breast tenderness pain is cyclical. This type of cyclical pain is usually observed in younger women less than 35 and affects close to 40 percent of individuals. It is believed that hormonal changes that occur during the menstrual cycle are responsible for the breast swelling and pain. The fluid retention that occurs just prior to the menstrual cycle often causes the breast to feel swollen and painful. As soon as the menstrual cycle is over, the pain immediately disappears. So far, the use of water pills and reducing sodium in the diet has not been shown to relieve this pain or breast swelling. Most women, however, do get relief from a non-steroidal anti-inflammatory dry like Motrin.

I am a 33 year old female and have persistent pain in my left breast. Can this be due to a cancer?

Breast tenderness causes a lot of anxiety in many women. The one major misconception women have is that breast cancer is associated with pain. In fact, it is extremely rare for cancer of the breast to present with pain. The majority of women with breast cancer have no pain. Breast pain has many causes and is often referred to as mastalgia or mastodynia. Close to 70% of women, experience some type of breast swelling tenderness at some point in their lives. This pain usually lasts 3-5 days per month and can be distressing. You can rest assured that pain last a few days is rarely cancer.