Follow Up Implants Still Too Far Apart and Under my Arm. 3 Months Post Op. What To Do? (photo)

Pre op I was 32A. I got 265cc Natrelle/full projection/round/textured/silicone gel. Under muscle/aerola incision. Surgery date Feb 6/12 I posted here b4 about my breasts being too far apart & I understand it may have to do with my anatomy, however I feel like the curve & swell is still mostly under my arm, especially when I lay down. They are still hard to push together into a bra, and still seem to be "stuck" to my chest. Still look uneven, & I have noticed some rippling when I bend over.

Doctor Answers 6

Lateral Displacement of Breast Implants?

Thank you for the question and pictures.

If you find that your breast implants displace laterally ( especially when you lie down), you may benefit from revisionary breast surgery at some point. This operation may involve internal sutures placed along the sides of the breasts (lateral capsulorrhaphy).  Closing off the breast implant pocket on the sides will serve to prevent breast implant migration to the sides (laterally).  Judicious opening of the breast implant pocket mediallly ( close to the cleavage area) may also help improve the breast implant positioning and your level of satisfaction with the results of surgery.

I hope this helps.

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Follow Up Implants Still Too Far Apart and Under my Arm. 3 Months Post Op. What To Do?

The photos demonstrate a pre operative asymmetry that was not considered in the choice of same sized implants. As for the supine lateral displacement I find your result acceptable. You need to discuss why the same size implants were used in an asymmetric volumed breasts (left was smaler than right and higher inframammary crease)

How to improve my breasts? (photo)

Your questions and difficulty with the implants are not uncommom, but I believe must be evaluated carefully in person, preferably by the operating surgeon, to develop a treatment plan that is most likely to suceed.   You submit good photos, but there are multiple technical aspects of surgery the online responder cannot know.  In general, to keep implants from lateralizing in supine position, textured implants good choice.  Width of implants should be broad enough to extend close to midline, as your pre-operative breasts do.   Positioning implants at surgery mandates slight medialization relative to your lateral nipples.  Post surgical bra to prevent dynamic muscular lateralizing force and close post surgical follow up to be certain of satisfactory developing result also important, in my opinion.

Steve Laverson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 40 reviews

Implants and pocket

First, you are limited by your anatomy a bit.  In addition textured implants do not move as easily as smooth implants. Some uneveness is also normal as the breasts start off a bit asymmetric.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 18 reviews

Post Op Questions

You have raised a number of questions so lets take them one at a time.

1) There are a number of issues to consider with respect to positioning of your implants.  The pocket dimensions are an important element in where the implants will be located.  If the pocket extends to the side the implant will tend to fall to that area.  That is especially true when you are lying down.  All implants will fall to the side when you are reclining so it really is normal and just a matter of degree.  

2) With respect to your inability to push them together, it is important to remember that your implants are under the muscle and the muscle will stop the implants from going too close over your breast bone.  Women who have little breast tissue, as is evident from your preop photo, will generally have a wider cleavage than women who have more breast tissue that can fill in between the implants.

3) Your comment about being "stuck" to your chest might be related to the textured surface of the implants.  This surface is supposed to act like velcro so the implants attach to the surrounding tissue.  When this occurs the implants will have less mobility and often feel stuck. When women with more breast tissue use this type of implant they can still move their breast tissue over the implant but when there is little breast tissue the entire breast may feel immobile.

4) Rippling is a known problem with all implants, more so with saline than gel.  Again, the textured surface may be contributing to this but also the fact that you are thin so that any ripples that are present have a greater likelihood of being visible.  Bending over is the most common position in which ripples are noted in my experience.

5) You have used relatively small implants that are full projection.  Understand that full projection implants have a smaller diameter as do implants with less volume.  This will also impact the perceived width of the implant and your cleavage.  It is important to match the implant diameter to your chest dimensions.

Overall I think your result is quite reasonable but you obviously have concerns.  Speak with your plastic surgeon about them so you can have a better understanding of these issues and see if you have any options to address them.

Richard Kofkoff, MD, FACS
Saint Louis Plastic Surgeon
5.0 out of 5 stars 49 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.