I have 10 yr old saline, under muscle implants. I've nursed three children. If I get them redone, can they make them closer together? They are so spread apart they are almost under my armpits. Can this be fixed? I want to avoid a lift, is that possible? Does it cost more to have them redone? What kind would you suggest? Thank you.
10 Year Old Implants: Too Far Apart and Rippling - Can They be Fixed?
Doctor Answers 19
Wide Set Implants Can Be Improved
To improve the position of the implants and prevent them from drifting toward your armpits, the size and shape of the implant pockets (the space in which the implants are sitting) need to be changed.
Closing the sides of the pockets will bring the breasts toward the center of your chest and prevent the excess drifting toward the armpit when you lie back.
Using an internal support will be an important part of success and preventing recurrence. This is done with a graft called Acellular Dermal Matrix, which acts as an internal bra to provide additional support to your tissues in maintaining the position of the implants.
To learn more about Acellular Dermal Matrix, check this website: lifecell.com
Please feel free to schedule a consultation for more careful evaluation and consideration of best alternatives.
Breast implant revision
You will need wider (gel) implants than you have to get closer to the midline and make cleavage plus you need the lateral pockets closed off so the implants don't drift out there again. This is not for the rookie surgeon so please go the the best and most experienced surgeon in your area. It will not be cheap but it should be worth it.
Breast implant revision?
Thank you for the question and picture.
Yes I think you will have an excellent results with revisionary breast augmentation surgery. This may involve removal of your current breast implants, capsulorraphy (repair of lateral aspect of each breast implant pocket with permanent sutures), possible use of allograft laterally if rippling is severe, and re-augmentation with silicone gel implants.
Before undergoing revisionary breast surgery it will be very important to communicate your goals with your surgeon. In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as “natural” or “C cup” or "fake looking" or "top heavy" means different things to different people and therefore prove unhelpful. Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup size may also be inaccurate. I use intraoperative sizers and place the patient in the upright position to evaluate breast size. Use of these sizers also allow me to select the breast implant profile (low, moderate, moderate plus, high-profile) that would most likely achieve the patient's goals. The patient's goal pictures are hanging on the wall, and allow for direct comparison. I have found that this system is very helpful in improving the chances of achieving the patient's goals as consistently as possible.
I hope this helps.
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Implants placed too far apart and has rippling
Usually saline implants needs to be changed every ten years, for several reasons. But in this case, the implants are too widely placed and this is a skinny patient. In this case, the pockets need to be revised. The implants need to be moved more medially and preferentially silicone gel implants needs to be placed under the muscle to help with rippling.
Rippling saline implants
This is actually not that unusual of problem. Most of us who do breast surgery have seen patients like you. My biggest issue with your situation is how thin you are and how much laxity there is in your skin envelope. Unless you go to a bigger implant ( I do not recommend), this is going to be tough to correct without a lift and removal of some of that skin to tighten your skin envelope. Changing your implant pocket and going from saline to silicone with a mastopexy to tighten your skin envelope will be required in this case in my opinion. Don't compromise and go to the best surgeon in your area. I hope this helps. Good luck. Dr. V, South Shore Plastic Surgery.
Implants too far apart
Some correction of your problem can be afforded by revision of the implant capsules by plicating the lateral pockets and expanding the inner pockets. Because you have minimal breast tissue and need to keep the implants under the pectoralis muscle, you will be limited in the degree of medial positioning of the implant and may have a bit more space between the breasts than you would find ideal. I would also suggest using silicone gel implants due to your thinness, which would reduce your chances of visible or palpable rippling.
I would advise gel implants under the muscle and a pocket modification either with capsulorraphy stitches or accelular dermis such as Alloderm or Strattice depending on the thickness of your tissues. I don't think you would need a lift. This will not be less expensive or easier that your original surgery. Revisional surgery is always tricky.
Breast implant revision
Different things could be done to improve your appearance. You may need some tightening in order to change the shape of your breasts. It is difficult to really tell just by the one photo. Changing the implants from under the muscle and using silicone implants should also help with ripples and positioning of them.
Implants Under the Armpits can often be Improved
I feel you can get breast that are closer together and less "under the armpits"
From your pictures, it appears as though your implant pockets are too far to the sides. Conceptually, this is pretty simple to address, however, we must still respect the native position of your breasts. From the position of your nipples, the breasts to appear to be "wide set" on your chest.
I'd estimate from your pictures that a breast lift could be avoided at this time.
My goal for a re-operation would likely be to make sure that we had a correctly-sized pocket that supports the bottom and sides of the implants to give a more natural, pleasing shape.
Costs and Implant Choice -- Silicone vs Saline
The cost for re-operation varied depends on the implants used (silicone implants are about $1000 more), the time anticipated for the surgery (likely a bit longer than your initial operation). An additional cost of perhaps $500-1000 would be required if a "Dermal Matrix" is used (yes, these things are costly!).
A consultation with an experienced plastic surgeon is your next step to review your goals, perform a careful examination and to go over potential options such as implant type and the technical details of a possible surgery.
Hope this helps.
Nick Slenkovich MD, FACS
Breat implant revision with acellular dermal matrix
Based on your photos I would recommend using a synthetic skin substitute which is also called Strattice. This will make it easier to recreate a new pocket and relocate your implants.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.