Would revision surgery help this huge gap between my breasts? (Photo)

1 yr post op subpec BA Mentor smooth round high profile gel implants - 225 ml on one side and 250 on the other. My surgeon told me that he could re-do my BA sub-glandular (at no cost) in order to move my implants closer together. I'm concerned that going sub-glandular is not the best solution for me as I am thin and bony chested. I've read about the "internal bra" procedure or Ryan technique and am wondering if that may be a solution for me.

Doctor Answers (12)

Would revision surgery help this huge gap between my breasts?

+1
Hello! Thank you for your question!  Given your history and symmetry and shape issues, consideration for either an acellular dermal matrix or mesh-type substitute is reasonable.  A capsulorrhaphy would be needed for revision of your breast pocket. If you do need such, the use of a dermal matrix or mesh may be considered if your tissue now has significant laxity that is failing in support or a significant deformity in which recreation of the breast pocket is required along with adding additional support and coverage of the implant.  Certainly, the larger the implant, the heavier the weight...thus, it may be useful to consider placement of a matrix or mesh. Otherwise, capsulorrhaphy for pocket revision using your native tissue should suffice.  It has been used safely and effectively to correct synmastia, restore the inframammary fold, mask implant issues (e.g., rippling, wrinkling, etc.), support the implant within a "sling", and improve aesthetic results in revisionary breast implant and reconstructive procedures.  However, only by physical examination would one be able to make recommendations on the benefits over the risk of using a matrix or mesh in your situation. 

Consult with a plastic surgeon well-versed in breast procedures and the use of dermal matrices and mesh in breast procedures who will assist you in determining which procedure(s) would be the best for you.


Scottsdale Plastic Surgeon
5.0 out of 5 stars 12 reviews

Do not put your implants on top of the muscle

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Thank you for your question and photograph. Your implants are too far apart which has nothing to do with placement on top or under the muscle. Implants on top of the muscle have a higher incidence of capsular contracture, more rippling, more fake looking and feeling and they get in the way more with getting mammograms. Your pockets need to be opened towards the midline and closed out to the side for repositioning. It can usually be accomplished with sutures alone and generally does not require insertion of mesh.  A Ryan procedure is to create the fold under the breasts which you already have.
Be sure that you are seeing a board certified plastic surgeon.

James McMahan, MD
Columbus Plastic Surgeon
5.0 out of 5 stars 11 reviews

Breast Augmentation Revision

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I do think you would benefit from a Breast Augmentation Revision - I agree that an internal bra with Strattice would help move your implants up and towards the center.  Your breasts look like they may have been slightly far apart to start with and this is something that would stay the same, but from this picture, it looks like your implants are too far low and lateral (to the side).  I do not think a subglandular placement would help.  Best of luck!

K. Roxanne Grawe, MD
Columbus Plastic Surgeon
5.0 out of 5 stars 14 reviews

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Laterally displaced implants

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Thank you for your picture. This can be solved fairly directly. I would recommend that you have your implants replaced going up slightly in size. Also would recommend using internal bra, STRATTICE, to support the new position of your breast augmentation. Additionally you will need some type of internal capsule work to additionally support your newly position implants.

Best Wishes. 

Earl Stephenson Jr, M.D., DDS, FACS

Earl Stephenson, Jr., MD, DDS
Atlanta Plastic Surgeon
5.0 out of 5 stars 8 reviews

Revision

+1
Thank you for your question and photos.  A before photo would also have been helpful.
Although the implants are widely separated, they appear to be centered upon the nipples and areolas. Moving them toward the center could leave you with the nipple and areola appearing to be on the sides of the breast, and unusual appearance to say the least. 

I would be very cautious about an attempt to put these above the muscle. I see only disadvantages. 

It would serve you well to consider another in person evaluation for a proper second opinion.

All the best. 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon
4.5 out of 5 stars 31 reviews

Closing the breast gap

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After augmentation the implant should be centered under the nipple and within the envelope of the breast. Some do have a wide chest though you might benefit from a different implant with a wider base, correction of the pocket, or both. Sub-muscular gives the best coverage so be cautious about the sub-glandular implant if your breast tissue is thin.

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 28 reviews

Wide cleavage

+1
Sorry to hear about your wide cleavage gap.  I would recommend you have the current pockets revised and keep you implants under the muscle.  Don't get too caught up in the technique.  Discuss it with your surgeon and see which technique has worked best in his or her hands.

Victor Ferrari, MD, FACS
Charlotte Plastic Surgeon
5.0 out of 5 stars 19 reviews

Would not move to Subglandular

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Dear tired, I would not move your implants to sub glandular as I feel you will have too much rippling.  I would use a piece of SERI mesh by Allergan to reconstruct the pocket and a larger submuscular implant.  This would move the implants closer together and also decrease the rippling you would get from subglandular implants.  You might discuss this with your plastic surgeon.  Good luck

Steven Schuster, MD
Boca Raton Plastic Surgeon
4.5 out of 5 stars 3 reviews

Would revision surgery help this huge gap between my breasts?

+1
Moving the implants above the muscle may help, but there are the trade-offs which you mentioned. 

The "internal bra" may be an option but depends on the quality of your capsule tissue. Using a piece of biologic tissue may be better but has a high cost. 

Discuss the pros and cons with your surgeon. 

Karol A. Gutowski, MD, FACS
Chicago Plastic Surgeon
5.0 out of 5 stars 17 reviews

Internal bra?

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Internal bra is just a marketing  term for what plastic surgeon have been doing for a while, I think you will need a larger base width impant placed above the muscle. I would not add any acellular dermal matrix and I would be clear that you are going to see the implant and the result will be more obvious 

Ryan Neinstein, MD, FRCSC
New York Plastic Surgeon
5.0 out of 5 stars 36 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.