Had Revision Surgery (Capsulectomy Left and Capsuloraphy Right) Same Doctor, Results Worse? (photo)

I have 425 Mentor Silicone HP. Revision -muscle released medially and tightened laterally on left. Finally some relief of one yr of chronic pain and tightness. Right side medially and laterally tightened. Right breast now sits much higher (feels attached to armpit & shoulder) than left and is completely distorted with concaved shape on outside of breast. Opinions, bad surgical technique? Or improper implant selection? Can it be fixed? Yes, how? How do I address this @ postop? $15K spent

Doctor Answers (10)

Had Revision Surgery (Capsulectomy Left and Capsuloraphy Right) Same Doctor, Results Worse? (photo)

+1

I think your implants are in the right place but that you still have an excess of tissue that is falling off your implants. The last operation may have moved your implants up, but your breast tissue did not go with them! I would approach this now as needing a reduction and tightening of the tissue at the bottom of your breast and possible a lifting of your nipples as well...


Phoenix Plastic Surgeon
4.5 out of 5 stars 15 reviews

Breast Augmentation Revision

+1

   You should wait for several months before considering a revision.  Then find the plastic surgeon with ELITE credentials who performs hundreds of breast augmentations and breast augmentation revisions each year.  Kenneth Hughes, MD Los Angeles, CA

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 180 reviews

High profile implants in augmentation have high rate of asymmetry

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Thanks for your question and submission of pre and post pictures. Like others have said, it is difficult to accurately comment without doing an exam and reviewing everything that has been done. Looking at your preoperative pictures, you had an appreciable asymmetry. Hopefully the complexity of this was conveyed to you. In anyone's hands this would have been tough. I'm not sure why there was a need to use HP implants. There is a lot of data to show that these not only have higher rates of malposition and asymmetry, but also can distort the chest wall secondary to their pressure. If your desire was to have a more round shape, then the HP implants is the best for that. It does appear however that the revision improved things. Hopefully with time things will stretch some and you will feel more comfortable. I'm sorry for your frustration, but hang in there. I do think you have an improved shape from your original pictures. Best of luck!

M. Scott Haydon, MD
Austin Plastic Surgeon
5.0 out of 5 stars 38 reviews

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Concerns after Breast Augmentation/Lifting and Revisionary Surgery?

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Thank you for the question and pictures.

 Although online consultants may be tempted to provide you with advice, I think that your situation is far too complex to do so adequately. Good advice would necessitate in-person consultation;  this process would allow review of your past surgical history, your current physical examination, and your overall goals when it comes to size/shape of breasts.

 Unfortunately, anything less than in-person consultation cannot be precise enough;  on the other hand, any advice you receive online ( given the complexity of your situation) can be potentially confusing  and/or inflammatory.

 I would suggest that you communicate your concerns/questions with your plastic surgeon;  if you remain concerned about the  quality of advice or “technique”, you may benefit from in-person consultation with other board-certified plastic surgeons who can demonstrate significant experience helping patients with revisionary breast surgery.

 Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 684 reviews

Augmentation mastopexy

+1

Hi Geno75,

     Your current shape is less than ideal.  Both implants are sitting too high.  It appears you have excessive tightness in your right breast pocket, both visually, and as you described it, symptomatically.  You are still fairly early though, only six weeks from your last surgery.  These findings may still improve over time.  Therefore, a final judgement can not be made at this time.  A six month period would be adequate to make a final assessment.

     That being said, the combination of breast lift surgery along with augmentation is probably the most challenging cosmetic breast procedure.   There are multiple variables that must be addressed for that surgery to work well.  Additionally, all those variables must work in concert  to achieve a pleasing result. I believe you can get beautiful results when all the above are appropriately addressed.

     It is not your implant size or implant profile that is the issue here, by no means. You have plenty of breast tissue coverage and potential space to accommodate the 425 cc high profile implant.   There are a myriad of patients with your body stature and even less breast tissue coverage  than you  that do quite well with this sized implant. Opinions in the plastic surgical literature are bountiful, and good surgeons often disagree.   There are plenty of articles and opinions that do not incriminate high profile implants as some other plastic surgeons do.  I know of many successful plastic surgical practices where high profile implants larger than 425 cc's are often used with a very low complication rate.  In certain circumstances, high profile implants are the implant of choice.

Good luck,

Ary Krau MD FACS

     

     

Ary Krau, MD, FACS
Miami Plastic Surgeon
5.0 out of 5 stars 33 reviews

Had Revision Surgery (Capsulectomy Left and Capsuloraphy Right) Same Doctor, Results Worse? (photo)

+1

Very hard to respond over the internet. Best to seek in person second opinions. To me your size of implant too large. But you might have wanted that large of implant I do not know. Again seek in person opinions. 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.5 out of 5 stars 61 reviews

Unhappy Results After Capsule Results

+1

Although I can see a number of aesthetic problems with your result at this point, it is yet too early at 6 weeks to tell how the final result will be.

If the result is still not favorable to you in a few months, it can not only be salvaged, but I am sure greatly improved (depending on the starting point at the time).

Depending on physical findings, you will likely need capsule revision (otomy, ectomy, etc.).  I am not sure if the implant should be changed without an exam and and finding out about your goals.

My advice, try to be patient, good luck.

 

A second opinion may be a good idea, as nothing beats a hands on exam, with a access to all records.

sek

Scott E. Kasden, MD
Dallas Plastic Surgeon
4.5 out of 5 stars 45 reviews

Implants and lift

+1

I think the biggest problem you may have is that your implants are probably too big for you and they are causing distortion., but an exam in person would be essential.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 15 reviews

Revision Surgery Results

+1

Hello,

We really can't say if capsulorrhaphy and capsulectomy was the 'right thing to do' without photos from before revision.  However, I have three comments I can make regarding your situation.

Evidence from clinical data suggest that HP implants have the highest rate of complications compared to intermediate and low profile implants. The reasons for this are many, and go beyond the scope of this forum.

Merely based on photographs, your implant size appears too large for your chest anatomy. Once again, data is coming in suggesting that surgeons that use 'dimensional based planning' for implant selection have much lower risk of complications.  Despite these two facts, every day surgeons gleefully place very large, HP implants into patients.  This definitely contributes to the fact that 25% of all breast implant patients have a revision surgery within three years of their original surgery.  Why do they do this despite data has multiple reasons too, but one that stands out is 'market pressure': If one surgeon doesn't give the patient what she wants, she'll just go to the surgeon next door who will.

Finally, breast augmentation combined with breast lift has the highest risk of complications.  There's not a surgeon on the planet that doesn't get them. Hopefully they are minor and don't require surgery to fix; unfortunately sometimes they do.  All you can do is make sure your surgeon is considered an expert breast surgeon in your community with the right credentials: ABPS certified and ASAPS member. You may want to visit a few other surgeons.  If you think your guy has met those criteria, then you should discuss with him changing implant size and profile in any further surgery.

Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 28 reviews

Revision Surgery

+1

Thanks for your question and for the photos. It would really be helpful to see an intermediate photo just before the most recent surgery to see what was being treated. It is hard to comment otherwise on what was done. You have likely described all that was done, but it would help know if the implant size was changed and if the position (above or below the muscle) was altered. 

There is obviously a problem on the right side that is visible on the second photo, and it seems likely that after the implants have settled, will need to be addressed. 

At the postop visit, you will need to express the areas of dissatisfaction. I don't think your surgeon will tell you the right breast looks as planned. 

All the best. 

 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon
4.5 out of 5 stars 30 reviews

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.