Richard Baxter, MD

There are actually 4 options for implant placement: under muscle can be either dual plane or split muscle, and over can be subglandular or subfascial. For under muscle placement I prefer split muscle because dual plane can cause animation deformity. For over, subfascial is better. A consultation is needed to make a specific recommendation especially considering a lift at the same time.

A full diastasis repair with a mini tummy tuck requires an umbilical float. You could go that route, but in your case I think a full tummy tuck would be better.

Correction of animation requires muscle re-attachment. It works best when the implants are not removed, and changed to either the split muscle plane which retains upper pole and medial coverage (NOT dual plane which requires muscle detachment), or subfascial which may not be an option if you are too thin. The reason for this is because when implants are removed, there is adhesion to the muscle which can still cause some movement.

I am sorry to hear about your experience. The Galaflex was a good idea because you are very thin with minimal breast tissue and the capsulectomy removed even more tissue. I like Gala and use it a lot but with capsulectomy in a thin patient I would use ADM like Strattice. It is thicker and so provides more coverage, and helps prevent against recurrent contracture. Consider a higher cohesivity implant as well.

The Ideal Implant assets were acquired by a company called Bimini Healthtech, and rebranded as the Serene Implant. They should cover the warranty for rupture, for replacing the implants.

Assuming your question is for breast lift without implants, you should be able to get pretty good symmetry with a Benelli lift on the side that is lower. No one is perfectly symmetrical but I don't see anything in the photos that makes me think your case is particularly difficult.

If you are having issues with your textured Allergan implants, then it is a good idea to have them removed. They can be replaced with smooth implants. Whether or not you replace them, a capsulectomy should be considered because of the very low but definite risk of ALCL. This does NOT have to be done with the en bloc method, which is riskier and does not improve outcomes.

More likely there is a seroma or hematoma from a muscle strain. Capsular contracture develops slowly. If it doesn't improve soon, have it checked out by your plastic surgeon. This may actually put you at greater risk for a contracture but there are options to reduce that risk.

A full breast lift will give you the best results. Since one breast appears larger, a reduction should be done on that side, or both with more tissue removed from the larger side. Because of the weight loss, your skin my be stretched out and so I would also consider internal support (internal bra procedure) with Galaflex.

It is often beneficial to go subfascial rather than under muscle for athletic women, although this is not ideal in every case. Return to full athletic activity is a matter of a few weeks, but it is also important to consider the long-term implications of under muscle placement.