Tuberous Breast Revision May Require Capsule Release, Alloderm and Fat Transfer
Thank you for your important question. You need to be examined by your surgeon for his/her opinion.
From your description of hardness and the appearance of the photo it is likely that you have Capsular Contraction on the left side as well as a "double bubble."
These are complex issues to treat. Open capsulectomy and placement of Alloderm and Fat can help reduce the recurrence of the capsule contraction.
The double bubble is more difficult. Soft Tissue Expansion may be required to enlarge the original breast tissue to a degree where your infra mammary crease-the fold beneath your original breast-can be reconstructed.
These are complex reconstructive procedures and you need an examination by your surgeon and thorough discussion of the options
The photo is not as helpful as a real live examination, but it appears there may be some irregularity to the implant pocket that can be corrected.
Redraping the breast tissue to blend more harmoniously with the size and shape of the implant can help and there are some techniques that might improve the "double bubble, but this is often unavoidable with tubular breast reconstruction.
The use of acellular dermal matrix (ADM) has helped in reshaping breast pockets, tubular breast reconstruction and reducing capsule contracture (hardening). Ask your surgeon if you might be a candidate for revision with ADM.
Tubular breast deformity correction
When a patient presents to me with this problem, it is usually corrected with a periareolar mastopexy augmentation using a submuscular silicone implant. Occasionally a full mastopexy with augmentation is required to correct symmetry issues.
In your specific case it's very hard to see what you may need with one arm elevated.
Please keep the arms down in the photos
Arms at the sides is the way to do the photos. Yours doesn't tell me anything helpful because I can't tell how much of what we see it artifact of the arms or real. There are many ways to revise the tubular breast, they can be much better but rarely ever perfect.
Surgery to Correct Tubular Breasts
Surgery to correct tubular breasts is challenging. Without examining you, it is difficult to tell exactly what is causing your breast to take the shape it has. It is critical to figure out what is causing the deformity, as different causes will have different treatments. What is clear, however, is that release of the band of tissue stretching across your breast will be needed, and volume will have to added to the lower portion of your breast.
The most commonly performed procedures almost always augment the breast, either with an implant or using a woman’s own tissue. In addition to adding volume to the breast, the base of the breast must be widened to a normal size, the inframammary fold lowered and the internal constrictions that caused the tubular shape must be released with internal incisions. In addition, the areola is usually reduced in size.
Breast implants have traditionally been used to provide the volume needed to correct a tuberous breast. Although implants continue to be widely used, both perforator flaps and fat grafting can be used as alternatives to breast implants. In particular, the DIEP flap and the TDAP flap have been effective in correcting tubular breast deformity. By using your own tissue, complications unique to breast implants (implant leakage or rupture, rippling, and capsular contracture) can be avoided. Reconstruction using your own tissue means a having a reconstruction with tissue that is yours for life and without having to worry about needing to replace implants from time to time.. Since there is a great deal variability in the severity of tubular breast deformities, the approach or approaches best suited to you will depend upon the condition of your breasts and your goals for reshaping them. Depending both on the severity of the condition and on your insurance benefits, coverage for surgery to correct tubular breasts may be available.
Still A Chance For A Good Result With Revision of Tuberous Breast Deformity
A thorough planned probably multiple stage revision is needed to obtain the ultimate goal. Symmetry!
I believe if you had good symmetry and the scars were placed at the very edge of the areola you could get a very good result.
With your left arm raised it is difficult to know exactly what procedure you need. With this in mind, the left breast will probably require capsulectomy (removal of the scar that has formed around the implant) with radial scoring of breast (this helps the breast tissue spread out over the implant so that it doesn't look like your breast is sitting on top of the implant) and a subglandular (under the breast, not under the muscle) silicone implant along with a periareolar mastopexy (this would not be so much for the lifting effect, as to make the areola smaller and put the scar right at the edge). This could all be done through the "periareolar" (its not really quite in the right place) incision already present.
The right breast then could be lifted to match the left breast. At least a good periareolar mastopexy is needed (again to make the areola smaller and put the scar right at the edge) and possibly a vertical incision (from the nipple down to the crease under the breast) to help tighten the lower part of the breast.
This may seem like more scarring, but when you obtain a good aesthetic result with good symmetry and place the scars in the correct locations, they are less of a concern to most patients as the good far outweighs the bad.
Most of this could be done with one operation, but touch up procedures to make small adjustments are likely. They are usually small procedures just to make adjustments or improve scars.
You still have a lot of potential for a good or even very good result so don't give up hope!
Bad tuberous breast surgery results can be improved.
Hi! I think you can expect major improvement.
1) What implant you use is not the most important thing, but I recommend smooth walled, moderate plus profile, cohesive silicone gel breast implants. I would place them completely over the muscle. This position allows the surgeon to control shape the best, and with tuberous breasts, the shape is the problem.
2) The critical steps are releasing the internal breast tissue to correct the pointed shape, and reconstructing the fold under your breasts, which was disrupted at the original surgery.
3) The scars of course will always be there, but I think they can be improved a lot.
Revision of a tuberous deformity recosntruction can be difficult. It appears form your phots that you have a double bubble possibly from undermining the breast fold. If your breast is very tight and the implant doesn't move, you may have a capsular contracture. However, without examining you, it would be difficult to tell you what you need to have done to correct yoru problem.
Revision of tuberous breast
It sounds like the original plan was correct, but the scars widened and need to be revised. What I see in the picture is something not necessarily related specifically to the tuberous breast, but the muscle. What I have found is that the "double bubble" defined by the crease across the bottom of the breast is usually related to the muscle attaching to the scar capsule at that location. you can confirm this by contracting your pectoral muscles and observing whether it pulls up there (it's called "windowshading"). The submuscular position is also contributing to the widening between the breasts, because every time the muscle contracts it pushes them apart. Both problems can be most effectively corrected by putting at least part of the muscle back behind the implant. Here's an example (it's the 4th picture set): http://www.drbaxter.com/corrective_procedures.html.
Secondary breast revision possible
At least from examining this picture, it does not look like you the lower pole of the breast will require further attention. The first implant acted as an expander to give more skin excess. Secondary correction of a tuberous breast deformity in your case will require the following:
1. Total capsulectomy for the hard side(or both).
2. Revision breast lift with revision of the IMF (lower breast fold) and lateral breast fold.
3. Implant exchange to gel with or without pocket exchange.
4. Revision of breast scars.