Dropped & Boxy Again - what causes this? (Photo)

Dear A.Class.Act,
I understand your concern. However, without a proper assessment, it would be difficult to determine what is wrong. If you had anchor lift, that might be the cause of boxy appearance. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

The heavier implants will just drop down from the weight and stretching your own tissue. Please do not go larger. A little trimming could be done in the lower lateral part of your breasts, but you will probably return back to this shape because of the implants stretching your own tissue that was already stretched, loose, and sagging.

A Class Act
Dropped & Boxy Again
can happen with a revision or the initial augmentation mastopexy
Breast problems requiring revision
BOTTOMING OUT
This is the term given to implant displacement, where the implant drops down below the existing inframammary fold (natural crease beneath your breast). This may occur when the fold has been released excessively during surgery or may be due to factors of the patient’s collagen and tissue integrity. The implants end up sitting very low on the chest and there is lack of internal support for the implant itself.
Correction usually involves restoring the crease beneath your breast to its normal position. This involves internal reconstruction including the capsule around your implant (capsulorrhaphy). Sometimes a biologic fabric (Acellular Dermal Matrix) can be used to attach to the breast tissue internally and support the implant.
This corrects the placement of the implant, redefines the breast shape, and refines the internal fold.
For you changing the profile of your implant and size along with a mesh may be helpful
STRETCH DEFORMITY
This occurs when the breast fold is in the correct position, however, the length of the tissue between the nipple and the fold stretches. This may be due to the patient’s soft tissue inelasticity and/or the size or shape of the implant that is used. Skin laxity can change with age, pregnancy, weight changes, or heredity.
Correction of this problem usually includes skin excision as part of a mastopexy (breast lift/reshaping).
It may be necessary to use ADM to further support the breast tissue if too thin.
CAPSULAR CONTRACTURE
This is a condition where the capsule around the implant thickens and squeezes the implant making it hard and often changing the shape and position of the implant. It is more common in nicotine users (e.g. smoking or nicotine patches or gum). Effective treatment of the capsule frequently involves completely removal of the capsule (capsulectomy), and occasional incisions in the capsule may be somewhat helpful (capsulotomy). In the past, closed capsulotomy, in which the breast is squeezed until the capsule breaks, was used. Currently, most doctors avoid this technique because of complications associated with the technique and because the implant companies will void their warranty if this technique is used. At times it is necessary to change the position of the implant, either above or below the muscle, depending upon the initial position, changing the implants themselves and, on occasion, the use of Acellular Dermal Matrix (ADM) may be required to prevent continued problems. Although the published risk of capsular contracture is approximately 9-11%, in our practice it is somewhat lower after initial implant placement. Once capsular contracture occurs, the risk of problems with secondary surgery rises to between 25% and 40%. The use of Singulair and Vitamin E may be of benefit. If you had a Sientra Textured Implant placed as a primary procedure and a contracture occurs in the first two years after primary augmentation, then their implant warranty may apply.