hi everyone, i had a breast augmentation 5 months ago but very unhappy with the result... i was an empty 32b (uk, not sure if it the same) had 340g dual plane implant could you please tell me what you think has gone wrong and what would be the sest solutions?
Breast Augmentation - What Went Wrong?
Doctor Answers 8
Nothing Wrong, Except...
The implant surgery appears to have gone well, and the result is what you would expect from the approach taken. When there is significant breast ptosis like you have, an implant placed under the muscle, even partially, does not give an ideal result. Here are your 4 best options for your breasts:
- Mastopexy (breast lift) alone
- Mastopexy/augmentation together with subpectoral implant placement (smaller implant)
- Mastopexy alone followed by augmentation-2 separate procedures (subpectoral placement & larger implant)
- Augmentation alone, submammary placement (saline or silicone, silicone preferred)
The choice depends on YOUR desires for shape/size/scars/cost/recovery time. It appears you would have been fine with just a submammary implant, it is very straight forward to remove your current implants and reposition them in a submammary pocket.
David R Finkle, MD
You needed a lift is what went wrong
Even though your photos are not surgical standard I can see that both breasts were droopy preop, left worse than right. The implants actually look to be in good position and have just magnified the asymmetry you had all along. You need lifts to get a more youthful look and better symmetry.
Breast lift may be required
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Implant selection and subfascial placement for natural appearing breasts
There are two things that create the undesirable aesthetics. Firstly the implant base width appears to be too narrow for your chest wall dimensions. Secondly you have undesirable lateral inferior stretchning that is very common with dual plane placement. Placing breast implants under the muscle creates a few aesthetic problems. If you look at your picture, your breasts are too far apart at midline to have a natural appearance. any time your arm moves this appearance will widen and worsen. This is the reult of releasing the inferior portion of the pectoralis major muscle. The more superior origins will not allow the implant to sit in a natural place and the continual forces of the muscle constantly push the implant down and out. When this is combined with excessive undermining of the inframammary fold, the deformity that you are seeing results and continues to progress. This is a very common finding with submuscular placement. To understand these forces better, stand in front of a mirror topless, put your hands on your hips and push down onto your hip bones firmly. You will see both breasts move down and out. these forces over time always cause lowering, lateral displacement, thinning of the breast tissue and stretching of the skin. This is the reason that I use a unique technique in my practice called 'cold-subfascial augmentation.' THis technique leaves the muscle alone and out of the equation but should not be confused with 'above the muscle' which I would also not recommend. The cold-subfascial augmentation harnesses the strong structural power of the pectoral fascia to create a truly natural breast shape and act as a living structurally sound brassiere inside the breast protecting the breast from the pressure of the implant and forces of gravity.
I have seen many patients with identical problems to the one you present and in my opinion there is only one good solution- changing placement to a new cold-subfascial plane. All of the native inferior support of your breast is now violated and conventional techniques like capsulorrhaphy and neosubpectoral placement rely on structurally unsound scar that will surely stretch and recur. There are several mesh and biological products people use to restore support but these in my opinion do not offer lasting support or add new risks or unnatural feeling/appearance. In my experience, revising breasts such as yours with a subfascial plane can create a more beautiful and lasting augmentation then your original before the problems started. I hope this helps!
All the best,
Rian Maercks M.D.
What went wrong?
Not being privy to your conversations with your doctor it's hard to talk about right or wrong. There are different approaches and they each have advantages and disadvantages. Looking at your pre-op photos you do look like someone who is a candidate for a breast lift. Another option would have been to place your implants over your muscle. Both of these scenarios would give you some assistance with your concerns but do carry with them other issues to consider- cost, scars, capsule contractures, etc. The 'dual-plane' technique does have the ability to provide you with the appearance of some lift while still keeping your implants under the muscle. In your case, that was the only choice if, indeed, you were against having a lift. In that case, the result you have is quite reasonable. Not ideal.
PHOTOS: Breast Augmentation - What Went Wrong
One surgeon's advice: It appears your left breast was lower to begin wtih. At this point it looks to have settled below your crease. You may require left sided capsulorraphy and/or nipple lift and possible volume reduction
What went wrong?
From the photos you provided, I would agree that it is very difficult to assess what is going on, if anything. As Dr. Wallach commented, your arms are in different positions before/after which will naturally change the appearance and position of your breasts.
As with any surgery, the best person to comment on your results is the surgeon who actually performed the procedure. A discussion of expectations of what you expected and what actually resulted should be held and then you two should decide how to proceed from there. In addition, it sometimes helps to get a second opinion from another surgeon locally.
I hope that helps!
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.