It would be best to remove the capsule in its entirety. Then, the space can be modified going mm by mm seeing what has been done and what needs to be fixed. After the new pocket is created, a new implant should be placed in the space. This needs to be done by someone who has vast experience in this area. Revision surgery requires drains because the fluid is going to be generated when you operate on the scar capsule. If you provide a mechanism for the fluid to be removed (i.e. drains), the risks are lower. If the fluid accumulates because there were no drains, it will most certainly cause problems in the future.
It appears that you have "double-bubble" from lowering your crease below your initial fold. Revision surgery can improve your result. Seek a plastic surgeon that performs hundreds of these procedures, has great reviews and photos, and is an expert in this field.
From your photographs, you clearly underwent the wrong operation for your starting point. You would have been better served by a more aggressive breast lift to help center and elevate your nipples and areolae. The excess skin you presented with has accommodated the implant and facilitated its movement down and out on your chest. Also, your surgeon likely lowered your breast crease which is served to create a double bubble deformity with the descent of the implants. There are ways to improve your condition through tightening the breast capsule internally and performing a more definitive lollipop type breast lift to restore your anatomy to its proper position on your chest.Be sure to find a board certified expert in revision breast surgery before you proceed.
Best of luck,
Vincent Marin, MD
San Diego Plastic Surgeon
Thank you for sharing your questions and photos on RealSelf.You seem to have displacement of your implants both outward (noticed when lying down) and downwards. One of the reasons why this may have happened is that the surgeon lowered your crease in order to elevate the breast and be able to perform a minor lift with scars only around the areola. Unfortunately, this hardly ever works. Lowering the crease disrupts the tissues that maintain the crease. At the same time, an implant below the muscle could put pressure on the crease when you use your pec muscles that will also push the implant downwards.This is why some surgeons will only recommend a standard lift with anchor scars so that we do not have to disrupt the crease. Also, this is why some of us use textured implants to lower the risk of implant displacement as well.There is hope. My recommendation would be to remove the implant, reconstruct the crease to its normal position, place a textured implant and do a good standard breast lift. The anchor scars will fade over time. They are never an issue with a woman when she sees how perky and natural her breast can be.Dr Spies