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Planning Revision Surgery After Breast Augmentation - Need Help

asked 1 year ago by vophsi12 in jacksonville
Latest answer by Otto Joseph Placik, MD
Question viewed 1,220 times
Tags: folds, inframammary, revision

I originally posted a question, "Can a lowered inframmary crease be corrected?" Many of you asked for pictures. I had my augmentation back in march of this year and my doctor has finally agreed to do a revision. The only thing that worries me, is that she seems a little unsure and admits to my case as being a challenge. We have discussed areola reduction, tissue release and removal to conform breast to implant, re-emphasizing fold, and larger implants. What would you do. I dislike my IMF :(

15 answers to Planning Revision Surgery After Breast Augmentation - Need Help

+2

Re: "Double bubble deformity" - Revision of breast augmentation

As noted by other respondents, you unfortunately have developed a classic “double bubble deformity” related to an inadequate release of the constricted inferior pole and with the submuscular placement and lowering related to the augmentation; the abnormal “double bubble” develops. Also the herniated retro areola breast tissue was not adequately addressed. Probably the best approach in your situation would be a periareolar incision, further release of inferior pole as... more
William F. DeLuca Jr, MD

Albany Plastic Surgeon

www.delucaplasticsurgery.com

+1

Double bubble deformity after tuberous or constricted breast augmentaiton with implants

I would agree with many other here in advising a circumareolar approach with areolar reduction, dual plane dissection with downsizing of implants, elevation of the inframammary fold, radial relaxing incisions, and possible neopectoral pocket or capsulorrhaphy and prolonged use of a supportive garment post-operatively.
Otto Joseph Placik, MD

Chicago Plastic Surgeon
+1

Unhappy IMFs

It appears that you may have had some constriction to your breasts prior to your surgery. I would suggest a periareolar approach with downsizing of your implants, reshaping the breast tissue internally and slightly reducing the size of your areola. I hope this helps. Dr ES
Earl Stephenson Jr., MD, DDS

Atlanta Plastic Surgeon
+1

Revision Surgery for Breast Augmentation

Thank you for your photos, these are immensely helpful. You have what appears to be a double bubble deformity but may in fact be an illusion given the previous constricted breast. If radial cuts in the breast tissue were not performed, this would explain the band across the lower pole of the breast. I would NOT recommend lowering the inframammary fold. For difficult cases such as these, I prefer a dual plane position of the implant and a supportive dermal matrix (Alloderm or Strattice) to... more
David Bogue, MD

Boca Raton Plastic Surgeon
+1

Breast augmentation for tuberous breasts

Thank you for the photos!  Very helpful.  Yes, you do have constricted breasts (also called tuberous breasts), which makes any correction challenging.  Here is how I would manage your case at this point:  circumareolar revision (scar around the areola to reduce the areolar size), release of the constricting bands inside the breast beneath the areola and in the lower pole of the breast, replace the same implants after suture reinforcement of the inframammary fold... more
Carmen Kavali, MD

Atlanta Plastic Surgeon
+1

Revision of Breast Augmentation to Correct Tubular Shape and Double Bubble

Hi there- I'm sorry you did not get what you wanted... It looks like you had a significant tubular or constricted breast shape prior to surgery, and that the lower pole was not adequately released. Combined with surgical lowering of your IMF and the fact that your nipple/areola herniation was not addressed, I agree you need a revision- these will not improve on their own. I am never comfortable recommending details of the procedure without examining you, but think that importa more
Armando Soto, MD

Orlando Plastic Surgeon
+1

Classic Double Bubble Deformity from Constricted Breasts

Dear Vophsi, Your photos demonstrate a classic "double bubble" deformity from constricted breasts that were not properly released at the time of the first surgery.  The correction of constricted, or tuberous breasts also oftentimes involves reduction of the areolae.  Your folds may also require elevation, which brings another level of complexity to your case.  Good luck!  see video
Kenneth R. Francis, MD

Manhattan Plastic Surgeon
+1

Revision breast surgery requires special expertise

The biggest predictor of the need for a revision with breast surgery is a previous revision; in other words, it is very difficult to get it right with a revision because they can be more complex than they seem. Analysis of the problem is particularly important. For example, the double bubble is typically attributed to a high inframammary fold, typical of the tubular breast, but this is not always the case. Your pictures show the constriction band going across the bottom edge of the... more
Richard Baxter, MD

Seattle Plastic Surgeon
+1

Breast implants and double bubble

I agree yours is a very difficult case. It looks like you started out with a mild variant of a tuberous breast with large areola and short nipple to inframammary creast distances. These mild tuberous breasts can be more difficult to deal with than more severe cases because sometimes the surgeon thinks they can get away with just augmenting the breast. As you have found out that does not always work. You will have to remove the implants, go back to square one, correct the tuberous breast... more
Aaron Stone, MD

Los Angeles Plastic Surgeon
+1

I would recommened pocket revision and not larger implants

I would recommend bilateral implant removal and reattaching the infra mammary fold,fat injection and mastopexy. I would come back in 3 months for implant placement or more fat grafting depending on the size you desire. This is not the conventional treatment and most plastic surgeons would disagree.
Kamran Khoobehi, MD

New Orleans Plastic Surgeon
+1

Planning Revision Surgery After Breast Augmentation - Need Helps

I agree with Dr Aldea's comments. Try and keep the same implants + either a release the constricted bands or an idea is also stem cell activated fat grafts to the inferior pole. I would not address your nipple/areolae at this operation but wait for 3 months for healing. Than if additional fat grafting or if the second operation is a failure than change the implant to above the muscle. As for using anatomic implants or the tear drop implants I totally disagree. Stay with the implants you... more
Darryl J. Blinski, MD

Miami Plastic Surgeon
+1

Correction of constricted breast post augmentation

You certainly have a double bubble breast shape.  This can be due to multiple factors including a constricted breast or tubular breast deformity.  You do have a relatively large areola and this goes along with a tubular breast deformity.  In any event the treatment may be the same.  It the implant is submuscular your plastic surgeon can consider changing to a subglandular pocket with radial cuts in the breast tissue.  This will help the breast tissue splay out over... more
Jeffrey Zwiren, MD

Atlanta Plastic Surgeon
+1

Breast aug revision

Hi Vophsi12, Thanks for sending for the photos.  Your original preop photos would be helpful as well.   I agree that the lower pole needs to be released more as described by Dr. Aldea.  I would also suggest considering using anatomic (teardrop) shaped implants.  These implants are good in this situation because the majority of the "fill" is in the lower pole and you are deficient in this area.  The level of the fold has to be carefully measured; the... more
Tracy Pfeifer, MD

Manhattan Plastic Surgeon

drpfeifer.com

+1

Breast augemtation revision surgery needed

Well it appears that your inframammary fold was completely released in an atttempt to enlarge and reshape your breast. I do not see your preoperative photos but your breasts appear to have a variation of tuberous breast deformity. Your doctor needs to recreate your fold,release your constricted breast tissue and reduce your areolar size. You made need alograft material to support your fold. All this done with the augementation. Do not go larger. That will make it worse. Good luck. more
Sheila Bond, MD

Montclair Plastic Surgeon
+1

Revision Breast Surgery ina Constricted Breast

You appear to have had a constricted breast which was not sufficiently released at the time of the last operation. The lower half of the breast is still constricted and has a straight rather than a convex appearance. The nipple complex demonstrates some fat herniation and the fold of the breast, the IMF, is still visible. To make the breast appear more attractive the lower pole constriction must be released from the inside with radial cuts. This will allow the implant to dictate the shape... more
Peter A. Aldea, MD

Memphis Plastic Surgeon

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