Will a Revision Fix my High Implant Placement?

I had surgery 4 months ago. The Dr. placed High profile 550cc silicone implants under the muscle using the axillary approach. My implants are so high up on my chest wall they are touching my clavicle bones.

I originally had 300cc saline implants over the muscle.The implants never dropped, I am considering having a revision done in June, using the periareolar approach . How high are the chances that my implants will remain high even after the revision?

Doctor Answers (21)

Superior malposition of breast implants

+3

I agree that your result is unacceptable. the good news is that superior malposition of implants is one of the easiest fixes for plastic surgeons who specialize in revisionary breast surgery. I agree with performing a periareolar approach and performing an inferior capsulotomy or partial capsulectomy. Your chances of success are very high.


Del Mar Plastic Surgeon
5.0 out of 5 stars 12 reviews

Implant revision

+3

First perhaps your body can not accomodate for such a large implant.  The other consideration is that the pocket was not dissected adequately from the transaxilary approach.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 17 reviews

Implant Revision Answers

+3

I agree that a revision is necessary at this point.  It is unlikely that your implants will drop enough to be satisfactory after 4 months.  A periareolar incision is appropriate as well.  I do think that you would be better served with a lower profile implant.  A Moderate Plus profile would give you a more natural look even after they are properly placed.  HP profile tend to look very "torpedo like" even in the best situations for augmentations unless you were completely flat chested prior to the augmentation.  I also recommend a breast strap after the repositioning for two full weeks in order to ensure the implants stay in the proper place while you heal.

Leif L. Rogers, MD, FACS
Beverly Hills Plastic Surgeon
4.5 out of 5 stars 16 reviews

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Implant revision

+3

I agree that the implants are too high. I think transaxillary approaches have a narrow "sweetspot" for getting ideal implant position because the space is created from above and outside the breast. I think a periareolar (or inframammary, for that matter) approach can help reposition implants by releasing the lower border of the scar capsule and possibly releasing breast tissue below the lower border of your pectoralis major muscle to let the implants sit lower in the breast skin envelope. Size may or may not be too large, as you may like the overall volume of your result. Whoever does your revision needs to be careful about not releasing the muscle near the breastbone border too much, or you may develop a degree of symmastia (both breasts touching each other without a defined cleavage  border separating them) with these large implants.

Obviously, whoever you go with, make sure your plastic surgeon for the revision is board-certified by the American Board of Plastic Surgery.

Tim A. Sayed, MD, FACS
Palm Beach Plastic Surgeon
5.0 out of 5 stars 14 reviews

Breast Augmentation Revision Requires Accurate Implant Position

+3

The quality of outcome associated with primary breast augmentation and revision depend on several factors.  Implant position is important.  If adequate release of the muscle and or capsule was incomplete when the implants were placed under the muscle, the implants will sit too high.  In addition, because you have a short nipple to fold distance, a large implant like these will likely give you too much superior pole fullness.  Saline implants are heavier and tend to drop a bit with time.  Silicone implants stay where you put them.  This is usually a good thing, however, if the implants are too high with silicone, generally a surgical approach is required for reposition.  I agree that an incision on the breast (periareolar or inframmammary) will allow the best visualization of the pocket to release the inferior breast and lower the implant.  Strongly consider a smaller implant as well as this will help with the balance of implant position on your chest wall.

Glen Brooks, MD
Springfield Plastic Surgeon
5.0 out of 5 stars 1 review

High riding implants

+3

I think revision using a periareolar approach would be helpful. I agree with the other comments that the implants seems a bit too big for you. Having said that, lowering the fold along with capsulectomy will allow the implant to drop and you may be able to keep the same implants.

Moneer Jaibaji, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 3 reviews

Revisionary breast surgery

+2

 Much of the final “look” achieved after breast augmentation revisionary surgery  depends on several factors:

1. The initial shape, size (volume of breast tissue), symmetry of the patient's breasts. In general, the better the  preoperative breast appearance the more likely the breast augmentation “look” will be optimal.
2. The experience/skill level of the surgeon is important in determining the final outcome. For example, the accurate and gentle dissection of the breast implant pockets are critical in producing  long-term  well-placed breast implants. I personally think that these 2 factors are more important than any others, including type (saline or silicone)  or model (low/moderate/high profile)  of implant.
3. The type of implant used may  determine the final outcome, especially if the patient does not have significant covering breast or adipose tissue. For example, some surgeons feel that silicone implants have a more natural look and feel than saline implants because silicone gel has a texture that is similar to breast tissue. Each patient differs in the amount of breast tissue that they have.  If a patient has enough breast tissue to cover the implant, the final result will be similar when comparing saline implants versus silicone gel implants.  If a patient has very low body fat and/or very little breast tissue, the silicone gel implants may provide a more "natural" result.
On the other hand, saline implants have some advantages over silicone implants. Silicone implant ruptures are harder to detect. When saline implants rupture, they deflate and the results are seen almost immediately. When silicone implants rupture, the breast often looks and feels the same because the silicone gel may leak into surrounding areas of the breast without a visible difference.  Patients may need an MRI to diagnose a silicone gel rupture.   Saline implants are also less expensive than the silicone gel implants.
Other differences involve how the breast implants are filled. Saline implants are filled after they’re implanted, so saline implants require a smaller incision than prefilled silicone breast implants.
On May 10, 2000, the FDA granted approval of saline-filled breast implants manufactured by Mentor Corporation and McGhan Medical. To date, all other manufacturers’ saline-filled breast implants are considered investigational.
As of 2006, the FDA has approved the use of silicone gel implants manufactured by the Mentor Corporation and Allergan (formerly McGhan) for breast augmentation surgery for patients over the age of 22.
4. The size and model of breast implant used may  make a  significant difference in the final outcome. Therefore, it is very important to communicate your size goals with your surgeon.  In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as “natural” or “C cup” or "fake looking" means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup  size may also be inaccurate.
I use  intraoperative sizers and place the patient in the upright position to evaluate breast size. Use of these sizers also allow me to select the breast implant profile (low, moderate, moderate plus, high-profile) that would most likely achieve the patient's goals. The patient's goal pictures are hanging on the wall, and allow for direct comparison.
I have found that this system is very helpful in improving the chances of achieving the patient's goals as consistently as possible.
By the way, the most common regret after this operation, is “I wish I was bigger”.
I hope this helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 756 reviews

Breast implants: too large and too high

+2

Hello,

Why were larger implants placed during your revision?

Your current state of affairs appears to feature high placement of large implants without adequate soft tissue to allow descent. I would likely advise smaller implants, but can't be definitive without examining you first.

 

Best Regards,

John Di Saia MD

John P. Di Saia, MD
Orange Plastic Surgeon
5.0 out of 5 stars 23 reviews

Poor implant placement

+2

A revision of your current implant position can be achieved.  Using a periareolar approach will allow  access to the space under your muscle much more easily allowing the implants to be lowered.  It is also entirely possible that the wrong implant was chosen for your chest wall dimensions.  If your anatomy does not allow a certain size, any approach will lead to a poor result.  I would highly recommend considering a smaller implant.  

Naveen Setty, MD
Dallas Plastic Surgeon
5.0 out of 5 stars 24 reviews

Will a revision fix my breast augmentation?

+2

The chances that a revision will lower your implants depends partially upon whether or not the original scar capsule was released/excised during your last revision, as well as whether or not the lower portion of the muscle was released.  If they were not released, additional implant volume tends to go up toward the clavicle, and releasing them may help.  You may also wish to confirm that the width of your current implants is appropriate for your frame – excess width also results in excess height, and these implants may be too large for your frame.

Craig S. Rock, MD
Houston Plastic Surgeon
5.0 out of 5 stars 18 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.