Do You Agree with my PS? Do You Feel I Should Let It Be? Or is There a Better More Effective Method in Fixing It? (photo)

I had slight tubular breasts. I got a breast augmentation in sep.2011. I originally was a about a 34B. I got 500 cc silicone implants high profile in each breast, now I am a 34D. My left breast still has some constriction. It almost looks like an indent. My PS doesn't think it is worth going back into surgery over but if it truly bothers me that he would go back in through the same incision, and make slices in the scar tissue which when healed should get rid of that constriction crease.

Doctor Answers 7

Correcting double-bubble deformity

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The usual caveats apply to assessment and advice from limited photos and no exam but this appears to be a type of double-bubble deformity. If the implants are above the pectoralis muscle then the deformity is caused by inadequate release of the constricted (tubular) breast. If the implants are sub-pectoral then the problem is a combination of too big (too wide) an implant, over-release of the medial edge of the pectoralis muscle to accommodate the implant, and inadequate release of the pectoralis muscle in the dual plane (from the breast tissues above it) as Dr. Gottlieb responded. 

If the pectoralis muscle is over-released it is hard to restore it (which is why implants should be sized and positioned properly (rather then forcing them to fit) but the pectoralis muscle can still be released in the dual plane or the breast connective tissue released in order to minimize the deformity. This requires a full surgical procedure with the implant temporarily taken out and replaced after the internal adjustment, so you would have to decide whether the cost and degree of correction was worth it. Different surgeons handle the costs of such revisions differently but usually the original surgeon will give you the best cost option as long as you have confidence in their ability to diagnose and correct the problem. 

Boulder Plastic Surgeon

Improving Breast Appearance with RevisionaryBreast Surgery?

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Thank you for the question and pictures. Although difficult to give you precise advice based on the limited photographs, I think that revisionary breast surgery may be very helpful to you. Of course, the surgery should only be undertaken  if you have concerns about the breast appearance and/or breast implant position. I am assuming that if you do not have these concerns you would not be posting online.

 Revisionary breast surgery will likely involve “reconstruction” of the inframammary fold areas. Capsulorraphy techniques (internal suture repair) are very powerful when it comes to improving these types of situations. You may find the attached link helpful to you as you do your “homework”.

 Best wishes.

Reasons Many Seek Breast Revision Surgery

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The most common reason women seek breast implant #revisions are to change their implant #size, and, capsular contracture . Capsular Contracture occurs in about 5-10% of breast #augmentation patients. However, only a small number of these patients experience pain or visual issues that actually require correction.  Additional matters of concern which many seek a revision are #malposition of the implant, changes in shape and size following pregnancy, weight change and also #deflation or #rupture of an #implant. Please be advised that each patient is unique and previous results are not a guarantee for individual outcomes. As with all cosmetic surgery, results will be rewarding if expectations are realistic. With any surgical procedure, there are some risks which your doctor will discuss with you during your consultation.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 116 reviews

Do You Agree with my PS?

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It would be helpful to see both breasts in one view, arms at the sides, and photos from before surgery in order to give best advice. 

Likeliest cause here is an impression from the original breast fold, but another is an impression from the lower edge of the pectoralis muscle. There are other possibilities, and the probably cause can be sorted out on exam. 

I find this to be a rather modest problem. The surgery is not a 100% correction, so I would tend to agree with your surgeon and recommend no surgery at this time. The decision is between you and the surgeon, though. 

All the best. 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon

Inadequate release of a constricted breast will require a revision.

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The groove between the areola in the infra mammary fold is due to inadequate release of the constricted breast. In your case it is relatively subtle saw not sure I would recommend a revision. However if you really are bothered by it only another operation will solve the problem. If your breasts were soft I would recommend you leave it alone.

Do I need a breast revision? It depends...

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Although there is no substitute for an in person exam you appear to have a double bubble deformity with the larger implant settling lower and the indentation is from your original breast tissue. There are procedures that can be performed to elevate the implant and possibly alter the position of the muscle in relation to the implant. I would recommend you continue to have open conversations with your board-certified plastic surgeon about your concerns so you can come to a mutually acceptable decision.

I hope this helps

Dr. Edwards

Revision breast augmentation can improve indentation.

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If this really bothers you, it can be improved.  It is very important to identify the exact cause for this problem, because there are several possible solutions.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

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.