Capsular contracture and implant malposition post weight loss mastopexy and breast augmentation

Objectives: This case report aims to highlight the management of capsular contracture and implant malposition following augmentation-mastopexy in a patient with massive weight loss. It emphasizes the challenges of breast reshaping after bariatric surgery, the psychological impact of implant-related complications, and the role of revision surgery including capsulectomy, implant re-implantation, and mastopexy in restoring breast aesthetics and patient satisfaction. Introduction: Massive weight loss following bariatric surgery frequently results in breast ptosis and contour deformities, often requiring augmentation mastopexy to restore breast shape and volume. Capsular contracture and implant malposition are recognized complications that can significantly affect aesthetic outcomes and patient quality of life. We present a case of capsular contracture and implant malposition following augmentation mastopexy in a post-bariatric patient, successfully managed with capsulectomy, implant exchange, and revision mastopexy. Materials / method: A 38 year old woman underwent laparoscopic Roux-en-Y gastric bypass, reducing her weight from 109kg to 46kg. Due to severe grade III breast ptosis, she then underwent bilateral augmentation-mastopexy using 350-cc microtextured silicone implants placed in the subpectoral plane with superomedial pedicle mastopexy. 12 months later, she developed bilateral capsular contracture, right-sided implant malposition, recurrent pseudoptosis, and associated depression. Revision surgery consisted of bilateral capsulectomy, implant explantation and re-implantation, revision mastopexy, lateral roll correction Results: Intraoperatively, thick fibrotic implant capsules and superior displacement of the right implant were identified. Complete capsulectomy was performed, followed by pocket revision and re-implantation of the existing silicone implants. Postoperatively, breast symmetry, implant position, and nipple-areolar complex viability were restored. At follow-up, the patient reported resolution of discomfort, improved body image, and no longer required antidepressant medication. No early postoperative complications or recurrent malposition were observed. Conclusion: Capsular contracture, caused by an exaggerated fibrotic response around the implant, remains a leading cause of reoperation following breast augmentation. When associated with implant malposition, it can significantly compromise aesthetic outcomes and negatively affect psychological well-being. Revision surgery involving capsulectomy, implant repositioning, and mastopexy is an effective treatment option to restore breast contour and symmetry. Early recognition and appropriate surgical management are essential for achieving long-term patient satisfaction and minimizing recurrence.