I had 325 moderate profile Mentor implants placed through the armpit and under the muscle about 7 months ago. They are still very high. I have been told that the muscle needs to be released and that my pocket needs to be cut a little lower and wider (towards the outside of my body). Assuming I want to stick with a revision through the armpit, is this an easy process? What is the general revision process and recovery time?The more detail, the better.
Process for Revision of High Implants?
Doctor Answers 10
Revision of “High Implants”?
Thank you for the question.
Revision of “high implants" involves lowering the breast implant pocket ( release of scar tissue and/or muscle). I think it is much better to approach this issue through an infra areolar approach as opposed to from a longer distance infra axillary incision.
Generally, this operation involves less recovery than the initial sub pectoral dissection ( given that the expansion of the sub pectoral space has already occurred).
Please make sure you're working with a well experienced board-certified plastic surgeon, well-versed with revisionary breast surgery.
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Breast Augmentation Revision in Los Angeles
Insertion of breast implants through the armpit or axilla has a much higher chance of having high rising breast implants due to the fact that it might be difficult for the plastic surgeon to fully release the lower attachments of the pectoralis chest muscles. It is possible to revise the position of your breast implants throught an axillary incision but an incision at the edge of the areola would definitely be safer.
Transaxillary Revision Breast Augmentation
Revision of high riding breast implants typically involves lowering the breast implant pocket including release of the existing capsule and/or muscle.
I have performed breast implant revision including correction of implant malposition through periareolar, inframammary, and transaxillary approaches.
I perform all of my transaxillary breast implant procedures (whether primary or revision) using a small camera called an endoscope. In my opinion, the endoscope is important because it allows the implant pocket to be created and/or revised under direct vision, which facilitates precise dissection, the stopping of all bleeding, and complete release of the lower border of the pectoralis muscle. This helps to avoid the problems of high riding implants and to minimize the chance of capsular contracture.
Larry Fan, MD
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Revision breast augmentation
Revision breast surgery for too high implants can be performed through either an infra-mammary incision, peri-areolar incision, or through the axilla. The procedure is the same and the outcome would be equally effective, depending on the surgeons skill and comfort level with the surgery. One approach is not any better than the others. If going through the axilla, the implants usually have to the ruptured in order to remove them, whereas using the other approaches the implants can be salvaged and put back in. The most important factor is not the approach, but the surgeons skill at revision surgery.
Breast augment revision
You are correct that you will need further release of the muscle at the bottom of the breast. It's just a little more complicated than that because the front surface of the muscle needs to be released for 1-2 centimeters from the back surface of the breast tissue. I would listen to all the other doctors that have advised a periareolar approach. You should get a very good outcome.
Revision of breast augmentation via the armpit incision
Patients who experience malposition of breast implants should consider a revision performed by an individual who is:
- Experienced with revision surgery of any kind and approach/incision
- Be able to show outcomes of revisions similar to the one being discussed via any of the incisions/approaches desired
In general, assuming that the original surgery was performed adequately, it does not seem reasonable to adopt the same operative plan and expect a different outcome. Revision of implant position via a trans-axillary approach is difficult but definitely possible.
Implant placement may require a revision. This is sometimes necessary through no fault of your own or the surgeon. The first consideration is who will do the revision. If the initial surgeon will do the revision I would recommend listening to what they have to say. Often individuals with little experience with a particular approach will offer recommendations which may or may not be appropriate. Depending on the specifics or your case an axillary or different incision may be appropriate.
Revision of breast pockets
Process for Revision of High Implants?
Sounds like you have a rare axillary incision outcome of high riders. Revision would be very difficult through the axillae. Recommend circum areolar or inframammary incision for better exposure.
Revision of Axillary Breast Augmentation
Unfortunately, it seems you have experienced one of the complications that is the primary reason I won't do trans-axillary breast augmentation... The good news is that I'm sure lovely breasts are still possible for you-
Considering what you've already been through, and the importance of getting it right this time, I would not recommend trying to achieve your goal through the armpit again. I think the risk is too high of you continuing to be unhappy and needing a THIRD operation- all because you and your surgeon were reluctant to make another incision.
Think of it this way- if you have this second operation through your armpit in order to avoid another scar, but your breasts are still funny looking, will you be happy?
Conversely, if you have a new, pencil-line scar under your breast or around your nipple, but your breasts are beautiful, will the scar bother you that much?
My opinion is that nothing else matters unless the breasts are lovely, and that the chances of ending up with lovely breasts when problems are approached through the armpit are very low.
Think about this carefully... and good luck!