Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with progressive breast firmness, discomfort, and visible distortion following previous breast augmentation. Onset of symptoms noted [Timeframe]. Reports associated pain, tightness, and change in breast shape/position. Denies recent trauma or infection. Baker Grade [I-IV] suspected.
Clinical Examination Findings
Physical examination reveals [Right/Left/Bilateral] breast asymmetry with palpable firmness. Breast tissue is non-compressible, elevated, and exhibits restricted mobility of the implant. Baker Grade [I-IV] confirmed. No signs of acute inflammation, erythema, or fluctuance. Implant displacement or "high-riding" position noted.
Treatment Protocol
Management plan includes: 1. Conservative: Massage therapy, leukotriene inhibitors (Singulair), and close observation. 2. Surgical: Capsulectomy (total/partial) with implant exchange or removal. Discussed risks of recurrence, infection, and potential need for acellular dermal matrix (ADM) placement.