Worth Getting Breast Implant Revision? (Breast Asymmetry, Pectus, and Capsular Contracture) (photo)

I have R thoracic L lumbar scoliosis. I have asymmetrical concave pectus- caves in more on my R side, L breast sits higher. Few years ago I got silicone gel over muscle implants to up cup size from A to B and help asymmetry. I was semi happy with results and liked the gel implants I wanted, although R still smaller- but then capsular contracture developed on L side and L nip stretched. What is likelihood of greater success, or contracture again w/ revision? Could unevenness be better corrected?

Doctor Answers (6)

The capsule contracture can be corrected and should help with symmetry

+1

Hello,

Although the pectus will not be addressed the breast implant capsule contracture can and should be corrected.  Your chance of developing another capsule contracture remains elevated but if all of the capsule is removed, drains are used, massage is started in the post-operative period, and medication such as singulair are taken then your chance of developing another capsule contracture is less.

All the best,

Dr Remus Repta


Scottsdale Plastic Surgeon
5.0 out of 5 stars 81 reviews

Pectus, breast asymmetry after surgery

+1

Thanks for your question and the good photos.  From the description and photos, it seems that your surgeon has done well by you.

 

What I see now (since capsular contracture has formed) is:

1.Right breast is smaller and constricted

2.Right breast could use more lateral fill

3.Left breast has capsular contracture, distorting its desired shape--too narrow, too projecting.

4. Left chest wall projects more than the right.

5.Left areola is larger

 To improve these:

1. Larger implant on the right, widening the capsule to allow the implant to extend more laterally.

2. Replace left implant, perhaps with a smaller implant,  behind the muscle to decrease the chance of another capsule.

3. Consider an implant on the left with less projection than the one on the right. 

4. Reduce the right areolar size.

 

Discuss at length with your surgeon what his or her assessment and plan would be. Know that all these interventions can have expected or unexpected consequences, as you should be aware already from your course.

 

Best wishes and good luck.

 

 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon
4.5 out of 5 stars 30 reviews

Breast Deformity with Pectus Excavatum and Breast Implants....

+1

Yes, you do have a difficult situation, but one which I think could definitely be improved upon.  Your pictures are Great!  That is really a big help!

I would start by removing your L implant and capsule and placing a new implant under the muscle. I would also probably use a lower profile (flatter and wider) implant if you do not have that already.  Your areola can also be reduced on that side if you want. 
Secondly.... The biggest cause of your asymmetry is the Pectus Excavatum.  This can be compensated for sometimes (in minor cases) by using a larger implant.  In your case however, I would recommend having a custom made solid silicone implant made to fill in the defect, then place your breast implant on top of this.  You may also need something done to move your right implant away from the midline, but that will have to be determined during an in person consultation and even during surgery. 
Good Luck
Dr M

Daniel P. Markmann, MD
Baltimore Plastic Surgeon
5.0 out of 5 stars 69 reviews

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Revision augmentation

+1
You have a difficult presentation which involves not only the breasts but the lumbar scoliosis and the chest asymmetry. You could certainly consider revision, correcting the capsular contracture and peraps enlarging the right breast. Obviously, this requires serious consideration and extensive discussion with your plastic surgeon. Best of luck.

Robert L. Kraft, MD
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You have several issues going on, and no one thing will ever make your two breasts the same.  A similar volume can probably be accomplished but the shapes and position and size of the areola will not match.

Steven Wallach, MD
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Sternal anomolies and breast augmentation planning can be tricky

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Thanks for the photos - this is a tough situation to create a perfect result - I would say that limiting the amount of revisionary surgery related to implants is always a good thing. I think you've gone from probably a very asymmetric situation pre-op to a less asymmetric situation - and for that, your surgeon should be commended.

 

Without a plane-switch procedure from above to below the muscle - a capsulectomy would likely result in more scarring. Plane switch procedure would have to be done on both sides to maintain implant position symmetry.

 

I think you should hold off on revision until your surgeon thinks that the capsular contracture is progressive enough to warrant a revision.

Scott C. Sattler, MD, FACS
Seattle Plastic Surgeon
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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.