Hi everybody! My right implant is not centered under nipple. My surgeon is trying to tell me that it looks like I had asymmetry before, but after looking at the attached image, I don't think ANYBODY would say the implant is centered and there was no asymmetry before. The capsule is just too big and when I lie down it moves 4 cm towards the arm pit. So my question is: HOW can this be corrected? Can the capsule be corrected without removing the implant? How long should I wait for revision surgery?
Implant Not Centered - 5 Weeks Post Op? (photo)
Doctor Answers (12)
Lateral Breast Implant Displacement
You have laterally displaced areola present in the preoperative photo. If the lateral aspect of the pocket is closed, the implants will be brought closer together, but the nipple areola complex will be displaced laterally. Just make sure that you realize this when and if the pocket is repaired.
Implant Not Centered - 5 Weeks Post Op?
The pocket was dissected to laterally. Only revision surgery can help. Wait 6 months before re operation.
Lateral position of implant
Thanks for your pictures and question. It does appear that the right implant is placed laterally although that is likely due to your anatomy which does show laterally positioned implants. However, the picture with you lying down does show the implant move even further laterally which does seem to indicate that you would benefit from tightening of your capsule. This procedure could be done without changing the implant if you are happy with the size of your breasts and lack of cleavage. I would wait at least 3-6 months to allow good formation of a capsule to allow for a stronger repair.
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It is possible to correct laterally positioned implants
First, you do have nipples that are set laterally on your chest wall (towards your armpits), and this is always a challenge during augmentation surgery. The implant needs to sit a little more laterally to be centered under the nipple properly. Sometimes, though, it just moves too far laterally. This can be corrected, but it does require more surgery: a lateral capsulorrhaphy (capsular revision) with sutures or with the addition of an ADM (acellular dermal matrix, like Surgimend). Also, you should limit any chest exercises that overly flex the pectoralis major muscles, as those exercises tend to push implants laterally (into the armpit) and stretch the pocket in that direction. I would wait a few months before pursuing any revision surgery.
You can correct the lateral displacement of the breast implant with a capsulorrhaphy procedure in which sutures are placed internally to reshape the implant pocket. This does involve the removal of the implants, but they can be immediately replaced during the procedure. You can have the revision procedure completed at anytime now. The capsule is well developed by 1 month after surgery and you look to be well beyond that time in the healing process now. I would agree that your NACs were wide-set before your augmentation and this does make things a bit more difficult. You really don't need new implants, but if you were inclined to exchange them, I might suggest a slightly lower profile implant that has a wider base width.
Adjusting Right Breast Implant Asymmetry
You had very lateral position to your nipples before surgery and that always poses a problem a balance between centering the implants behind the nipple and not getting them too far to the sides. The differences you are showing before and after surgery are very slight although that is not to say there are not significant to you. While a revision can be done to tighten the capsule on the right breast to move it in more, you need to be aware that the risk of further malposition is not rare. The smaller the 'problem' is, the more difficult it can be done to make it perfect. You will have to balance that risk vs. benefit when determining whether you want to undergo revisional surgery.
The implant has to be removed to perform the correction, but can be immediately replaced at the same time. I would recommend waiting a minimum of 3 months to have the repair.
Implant Not Centered - 5 Weeks Post Op? (photo)
Your pre operative photos show that your nipples were very lateral.
Your surgeon correctly placed the the implants as centered to the nipples as possible.Had he place them any more laterally you would have had even wider cleavage
It is difficult to get optimal results in patients with lateral nipples,and correction can be even more difficult.
The technique that I use is to re open the pocket,dissect laterally and advance the lateral flap medially.The lateral flap has to be sutured to the chest wall .In order to prevent suture disruption and to have the ability to modify the shape and size after surgery ,I prefer using the adjustable saline implant
Lateral implant displacement?
There may be lateral implant displacement which can be best analyzed in person. Remember your anatomy may prevent you from having a lot of cleavage.
Repair of Lateral Breast Implant Displacement?
Thank you for the question and pictures. You have done a nice job, with pictures and measurements, demonstrating your concerns. Internal suture repair of the breast implant capsule ( capsulorrhaphy) will be necessary to prevent breast implant displacement and better center the breasts on the chest wall. In my practice, this repair is done with a 2 layered permanent suture technique. The use of acellular dermal matrix is an option ( although not usually necessary) especially if significant implant rippling/palpability is present.
During the procedure, the capsule close to the sternum may need to be opened as well ( reverse capsulotomy). Depending on your goals and measurements, changing breast implants may or may not be necessary.
I generally suggest patients wait at least 6 months before undergoing this type of surgery. In my opinion, the more developed/stronger the breast implant capsule, the better the repair ( sutures “hold” better).
I also think that postoperative management is very important in achieving successful results after this type of surgery. I advise my patients to keep their elbows by their sides as much as possible for several months after the procedure is performed.
You may find the attached link helpful to you as you do your “homework”.