Hello, I had my 1st BA in 2008 under the muscle but didn't like the result so I got them removed after 5 mths, waited almost a year, then went to another surgeon who redid them, over muscle (400 cc). But now my tissues have thinned out (implants more visible and palpable) and I'm worried that this will get worse over time. Will I be able to eventually go back under the muscle to better hide the implants? If not, do I have other options? Thank you
My Breast Tissue Has Atrophied After Subglandular Breast Augmentation. What Can I Do? (photo)
Doctor Answers (6)
Common problem: either implants are too big or pocket not dissected correctly
I deeply understand your concern.
What has happened (as you perfectly point it out) your breast tissue has atrophied with the pressure of the implant. I can give you two reasons of why that could've happened:
1. The implants are too big and the high pressure of its constant weight does cause a considerable amount of tissue atrophy.
2. The dissection of the pocket for the implant placement might have been done incorrectly, not leaving the whole mammary gland and fat tissue in front of the implant, therefore, the little atrophy (that regularly happens in breast augmentation) is more noticeable in your case than in most patients, and leaves too little tissue between the implant and the skin.
Something that is important to have in mind is how much breast tissue (meaning mammary gland and fat) you originally had for covering the implant. If it was not enough, a big implant will become more evident. This would leave reason 1 as the most probable cause.
Now, to answer your concern about how to fix this, I could immediately tell you that the best choice would be a smaller implant and, in your case, definitely go back under the muscle. At this plane we have more anatomy to use and cover the areas where the implant is becoming more evident.
The only bad news I could give you is that, because you would have an implant size reduction, it is likely you might need a breast lift combined with that procedure. The fact that you look young, does not make it 100% certain and your skin might retract pretty well, but in case you do need a lift, a round block breast lift could eliminate excessive skin and the scar would be around the areola, so it's practically invisible.
As I like to tell my patients: Big breasts eventually become really big problems.
Hope this explanation works and that you get the results you want and deserve.
Dr. Fernandez Goico
Soft Tissue Thinning After Breast Implants
Soft tissue thinning after breast implants can occur whether the implants are placed under the muscle or over the muscle. Risk factors include thin soft tissues pre-op and larger breast implants. It may be advisable to place breast implants under the muscle in patients with thin soft tissues but even so the implants may become palpable and visible particularly on the outside or lateral aspects of the breasts. Choosing smaller breasts implants is often helpful but a breast lift may be necessary. In some cases of severe soft tissue thinning the addition of acellular dermal implants over portions of the breast implants can improve visibility and palpability.
Thinned breast tissue after subglandular augmentation
Revisions can help but you will have to consider downsizing to minimize the continued effect of your implants on your tissue. A lift will be needed and your tissues in the inferior pole can be doubled in thickness if you overlap the layers rather then simply plicate. Make sure you communicate your concerns to your doctor and see what your surgeon says in response to what you expect. And of course, know what the revision policy is... you may need it.
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I am sorry that you are having problems with your implants. In general, I like to place them under the muscle. I will say that it looks like you need a lift as well on the right breast( left side photo)
It's always better to place implants under the muscle
When you place implants over the muscle you end up cutting most of the natural supporting ligaments of the breast so the breast will tend to elongate and look droopy over time depending on the amount of scar that has formed internally. Your breasts look like this now. It is possible to change you implants under the muscle again but usually extensive removal of the capsule on top of the muscle is needed. A careful examination will be needed to determine just how saggy your current breast is to determine if a lift is needed. The right breast looks considerably saggier compare to the left. Proper placement of the implants is important to properly center the nipple relative to the position of the implant.
My Breast Tissue Has Atrophied After Subglandular Breast Augmentation. What Can I Do?
Difficult to give you accurate/specific advice with the limited photographs posted. Generally speaking, patients like yourself may benefit from breast re augmentation with implants in the sub muscular position. Sometimes, depending on the physical examination, additional maneuvers such as breast lifting may also be indicated to improve the outcome. Additionally, the use of acellular dermal matrix may be helpful for patients experiencing significant rippling/palpability of the breast implants.
I hope this, and the attached link, help.