William J. Hedden, MD

Mesh to hold an implant up from bottoming out should not look any different then a normal breast augmentation. Currently the issue I see from looking at your pictures is that the remaining breast gland as pulled away to the sides and left just thin tissue or thin tissue with mesh covering the lower central portion. This is fixable. There are several options. 1)The best way to fix this which you likely will not want is to remove the implants and revise the lift then come back later to place the implants. This will allow the tissue that’s been pulled to the sides of the implants to be re-approximated. This will be the best way to fix it with the highest chance for the best result. 2) if you have silicone you could revise the lift as stated above and then switch the pocket to subglandular ( above the muscle) and just make sure to release or open it up enough at the top. This would let you fix it in one setting. 3)fat transfer to the area devoid of tissue. Not a good choice as it’s too unpredictable and may take several surgeries to get it close. 4) revise the lift bringing the tissue together, and then placing mesh in at the same time to help prevent the implant from putting pressure on the tissue at the bottom which lead to the separation. This could be done leaving the implant in place. The downside of this is that when the lower glandular tissue is brought back together if it does not have a period of time to heal before the weight of the implant is placed on it this is more likely to happen again. I have seen this many times from other surgeons and have fixed it will all of the above options but the best is #1, then next best option is #4. For more information please feel free to email us. Have a great day.

Dr Hedden

It seems as there is part of the result the surgeon is not happy with and he’s using the filler to camouflage that aspect in hopes it will fix it. This is never a long term fix and the issue presents itself again 6-8 months later. The only filler that may help right after surgery is radiesse as it is calcium based and has a better chance of staying.

We commonly do those together and the downtime is very minimal. You just want to make sure your doctor has significant experience with those procedures. In our office we perform those procedures almost every day. Most patients would be recovered enough to go back to work from the eyes and fat transfer within days. Currently something like that would run about 11,000$ at our facility. Best wishes.

The purpose for a cell saver system is when surgery ( primarily cardiac surgery where there is anticipated significant blood loss) is performed where there is anticipated significant blood loss the blood loss can be recycled to an extent. This is not without its own risk and complications( there are possible complications from cell saver usage, including compromising the patient's blood clotting efficiency, overloading the patient with too much fluid volume, causing an infection (possible anytime any fluid is transfused), accidental air injection during the transfusion, embolism). I have only seen a few doctors try to recommend this in their practice. Most of the time it was to up charge the patient and obtain extra revenue. Here is the problem if the doctor really believes it’s needed the first thing you should ask yourself as the patient is since this is not common at all then why is your doctor having more blood loss than other surgeons to the point that he feels it’s needed?? . I’m sure if his medical board reviewed this practice for elective surgery it would raise significant questions as to why this is being performed in an office setting and why is so much being done that there would be the anticipated amount of blood loss to justify using this device. Lawyers would have a field day on this surgeon. Poor poor clinical judgment. I would run away and seek multiple other opinions.

Thank you for your question. I have seen this before with several patients from other physicians. Typically those patients had either 1)a capsular contracture which was forming and pushing the implant towards the weakest spot, which is the incision. 2)The other cases have been where the implants were below the muscle but the inferior attachments of the pectoral muscle had either been released because of a biplaner or dual plane technique or they had released on their own with time. When this is the case the support for the implant is no longer present and any excess use of the pectoral muscles with push the implant down and out eventually thinning the tissue with eventual erosion through the skin. When you can see the breast implant through the skin which is identified by the blue coloring it’s only a matter of time before that implant will road through the skin and you’ll have to have your implants taken out for a period of 6 months or more before re attempting to put them back. The problem with waiting for this to happen is that it will happen and then the result will be very difficult to get them to look normal again. You’re at a point now where the best course of action would be surgery to release any capsule that may be present pushing the implant towards the incision if that is the cause Or if the capsule is normal then consider switching the implants to above the muscle so you take away the force pushing it downward. Simply repairing the area or incision is not enough otherwise it will come right back. This needs to be performed sooner than later. Otherwise the complications will eventually happen and you will never be able to have a great result.