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.

I have been diagnosed with breast cancer and am thinking of going to a breast health center, instead of my doctor. Do you think this is okay?

Women who want comprehensive care of their body from trained specialists should visit a breast health center. In the last decade, many women’s breast health centers have opened up to cater to the medical needs of women of all ages.  Breast cancer is the 2^nd leading cause of cancer deaths among women. The solution to survival is early detection through regular self-exams and annual mammograms. However, many women have an unknown fear about mammograms, breast biopsies and male doctors. For this reason the majority of breast health centers are staffed by all female professionals who offer more private, personal, warm and relaxed environment. Moreover, these health centers also provide onsite radiologists who will quickly read your mammograms. The centers also have several types of cancer specialists who will provide you with the best options to treat your cancer.

How is paget’s disease of the breast usually treated?

The treatment of Paget’s disease of breast requires surgery. The type of surgery depends on the extent of cancer and size of the mass. Surgery options include a simple mastectomy –which entails remove of the entire breast but the lymph nodes under the armpit are not removed. If the lesion is small, the surgeon may perform a lumpectomy. This breast conserving surgery only involves the diseased portion of the breast along with the nipple and areola. 

Most patients under go radiation therapy afterwards to ensure that all cancerous cells are killed. Lumpectomy is not recommended if the female does not want to undergo radiation therapy afterwards. However, plastic surgeons can help reconstruct the nipple and make the breast look cosmetically acceptable. After surgery, some women may also undergo adjuvant therapy with anti cancer drugs or hormonal therapy. The type of treatment will depend on certain tests  and presence of certain receptors on the breast cancer cells.

Does paget’s affect both breasts normally?

Paget’s disease of the breast is a rare disorder which usually presents with features of an eczema or dermatitis centered around the nipple. Paget’s disease of the breast is usually seen in older women and is often mistaken for a skin rash. The skin around the nipple appears red, may be crusty, scaly and may itch. On physical exam, there is usually a mass felt under the nipple. Paget’s disease usually affects one breast. The skin changes tend to fluctuate and often the diagnosis is delayed. The delay in diagnosis is usually an error on part of the doctor- who treat it as an eczema. The cause of Paget’s disease of the breast is not known but it is widely believed that some underlying cancer cells travel though the milk ducts to the nipple and spread on to the surrounding skin.

How long does a silicone breast implant last?

There is no procedure that will give you a younger, attractive looking breast forever. Implants usually last a few decades if you look after them. Today doctors to recommend that you have regular MRI after an implant for the first few years, but this is costly and you have pay for the test. Breast implants are great and can turn you into an erotic goddess. However, when things go wrong, you will wish that you had never heard the word plastic surgery before.

What are the options when there is a breast implant rupture?

Well, the treatment depends on the size of the leak. If the leak is very small, then the surgeon may just observe it, especially if you do not have symptoms. The typical options include removal of the implant and allowing the tissues to heal. After a few months, if you still have money, you have the implant back again. If you do not like silicone, you can now go with a saline implant. If you have had enough of breast implants, then you have two choices, one is a breast lift which will cost you another $3,000-$8,000 or you have to learn to like saggy breasts- and that may mean taking some prozac also.

How can I be sure that my breast implant has ruptured?

Most women will feel that something is not right with their breast. If you have any of the symptoms discussed above or feel that you have damaged your implant, it is best to see a doctor. Breast implant rupture can easily be diagnosed with an MRI. Other tests, which can also be used to detect rupture, include ultrasound or CT scan. Of course, these tests will also cost anywhere from $ 400-$1,000

What are the usual features when a silicone breast implant ruptures?

In most cases, when the leak is small women generally do not have any symptoms or outward signs. However, if the leak is mild to moderate, most women will have the following symptoms:

- Pain of varying degrees-in most cases it is bearable

- Some women may experience a burning or tingling sensation at the site of rupture

- Others may experience numbness at the site of rupture

- If the leak is significant, it may also cause the skin to become red

- In almost all cases, the area around the leak is firm and hard. The texture of skin will definitely will different

- The breast may feel knobby or woody

- In some cases, the breast size and shape may be distorted

Can a small leak in silicone breast implant change shape of my breast?

After a silicone breast implant, if you have pain or change in the shape or size of your breast, a leak must be ruled out. When the breast implant is first inserted, a fibrous capsule or scar tissue forms around the implant. When the silicone leaks, it incites an inflammatory reaction of this scar tissue. This will present as pain and hardening of your breast. You will notice that the skin texture around the leaked site is different or firm. Many women complain of an odd ache or discomfort when a leak occurs.

I had silicone breasts implants recently and think I may have a rupture. Is this dangerous?

Breast implants are sturdy and durable but they sure can rupture. When a breast implant ruptures, the silicone leaks around the breast and can cause development of a thick firm scar. This may lead to pain and asymmetry of the breast. You will definitely notice a chance in the contour of the breast. Over the years, there has been a lot of controversy if the ruptured implant can cause cancer or other collagen vascular disorders. Some people say it does and some say it does not. The best advice is to see your surgeon and let him decide the next course of action. You can rest assured- managing a ruptured implant is an expensive undertaking.

Are breast lumps common in young females?

Breast lumps are quite common in young females. The lump is essentially a growth of tissue that develops in the breast tissues. Some women refer to a breast lump as a swelling, fullness, thickening or a mass. Most women first identify a breast lump  accidentally. Sometimes the mass may be discovered by a prudent physician who performs a physical exam. In the majority of cases, breast lumps generally do not have symptoms. However, in rare cases the breast lump can present as redness around the nipples, dimpling or tethering of skin, unequal breast size, nipple inversion or a bloody nipple discharge. In a few rare cases, the lump on breast may present with a skin rash or dermatitis. It is very rare for a female to complain of a painful lump in breast.

Findings of a breast lump does not always mean that one has a cancer. There are many causes of breast lumps in young women. However, breast lumps in postmenopausal women should always be of concern.

I am a 29 year old female and have been told I have fibrocystic disease of the breast. Is there any thing I can do to make it go away?

Fibrocystic disease is also common in many women in between the 3-4 decade of life. The breast usually feels lumpy and uneven. Physicians often refer to fibrocystic disease as glandular disease. Fibrocystic disease is found in more 50% of women at some point in their lives. Today, it is believed that fibrocystic disease is not a disease at all, just a variation of normal growth.  Women who have fibrocystic disease do complain of pain or discomfort in the breast. However, the disorder is not life threatening and disappears after menopause. Simple homemade measures like wearing a support bra and avoiding caffeine beverages is all that is required.

My doctor says I have a breast cyst. I am 32; Can you tell me what I should do next?

Breast cysts are fluid filled sacs in one or both breasts. The cysts are round and have distinct margins. When examining the breasts, the cyst will feel like a grape. Very rarely will a breast cyst will feel firm. Breast cysts tend to be more common in women in the ¾ decade of life but may present earlier. In most cases, breast cysts disappear after menopause. Breast cysts generally do not require treatment unless they are large, causing pain or the female just wants it removed. In most cases, surgery is not required but the cyst can be drained with a needle in the office. Unfortunately, breast cysts do come back but they are not life threatening nor are they cancerous.

Does breast feeding cause sagging of the breasts?

One common reason why many women are afraid to breast feed is because they believe that their breast will become saggy. This myth of gigantic proportions has been perpetuated over the centuries chiefly because of ignorance. Sure breasts can become saggy but this is not due to breast-feeding. 


A lot of recent data shows that breast feedings does not affect the size, shape or volume of the breast. During all pregnancies, breasts are engorged and appear bigger. The ligaments that support the breasts also are stretched and often after delivery, the ligaments lose their elasticity and the breasts sag- so breast-feeding is not the reason for sagging. Unfortunately, breast sagginess does tend to increase with each successive pregnancy, and this is especially true in women who already have large breasts.  To day, there is no medical treatment for saggy breast except cosmetic surgery