Recognizing tuberous breasts and treating them with focused techniques is the answer
Unfortunately the problem has very little to do with the implant selection. In my opinion this problem has more to do with diagnosis. You started with anatomical findings that are classified by plastic surgeons as 'tuberous breast deformity.'. The findings include your narrow based breasts, high inframammary folds, large areolas and subtle breast herniation through the areola. Tuberous breasts can be very difficult to treat and itnis essential to diagnose accordingly and plan surgically based on the findings. Although I choose to handle most mild to moderate tuberous breasts in a single stage procedure, staged procedures are certainly acceptable. I think of staging the procedure when the highest and lack ofmcompliance of the inframammary fold is too high. In these cases it may be necessary to use tissue expansion or other modalities to release the fold. In my practice judging by your pictures, I would recommend a single stage with a specific procedure that I have tailored for tuberous breasts. I use a unique hidden scar areolar reduction technique that also yields a 1cm lift(appropriate for you) combined with a cold-subfascial prepared plane for a controlled and supportive implant pocket and an aggressive sub dermal release and scoring to lower the inframammary fold without a double bubble. Double bubble deformity is certainly a risk in patients with morphology such as yours but can be avoided and treated. Any technique that successfully drops the implants 1-2cm, lifts your nipples about 1cm and provides slightly wider implants will be a nice improvement. I hope this helps! All the best, Rian A. Maercks M.D.
Anatomical implants for athletic patients can work fine in selected patients.
Style 410 implants from Allergan and CPG implants from Mentor are the only anatomically shaped silicone gel implants available in N. America. In the USA, neither of these implants is approved for primary breast augmentation outside of a clinical study environment. In Canada, we have had access to these implants for breast augmentation for about 10 years and some of us have gained a lot of experience with these highly cohesive and textured implants. I recommend them for approximately 50% of patients that I currently see.
These implants do have firmer and more cohesive gel than round silicone gel implants currently available in the US. The more highly cohesive gel results in an implant that can maintain it's shape better than round implants. This property has been demonstrated to reduce risk of rippling, shell folding, implant rupture and these devices are associated with a lower incidence of capsular contracture compared to round cohesive gel implants. These implants do feel a bit firmer but this not a major problem or concern for patients who have them. Rotations can occur but precise surgical technique has resulted in a very low incidence of this occurring in multiple published studies. The Pivotal study identified malrotation in only 2.3% of patients. Overall the rate of revisional surgery with Style 410 implants is significantly lower than with round silicone gel implants when all factors are included.
For athletes, the lower body fat, less breast tissue coverage and higher levels of activity all need to be factored into the discussion. Smaller implants, carefully positioned and most often placement in a sub-pectoral location can be a good approach. Your pre-operative breast shape and anatomy made achieving optimal results with any implant challenging. However, your photos suggest that the implants are too large for your tissues, have been positioned too high, are positioned asymmetrically and you likely have had inadequate release of the pectoral muscle on both sides. Your shape may improve substantially over the first 12 months so wait and see before considering revisional surgery.
Athlete with "anatomical" implants may have made the "wrong" choice.
So-called "anatomical" implants are teardrop-shaped (more) cohesive textured-surface implants designed to shape the breast and give a certain post-operative appearance, rather than "filling" a breast whose shape is not being altered by any sort of lifting or skin-reducing incisions. Unfortunately, when you are reclining, "anatomic" teardrop-shaped implants do not flatten, become round, or drop to the side slightly (like normal larger breasts do), but rather remain upright and tear-drop shaped without much movement (if any). The latter, I would suggest, is NOT anatomic, whereas round smooth implants are teardrop-shaped when upright, and become round, drop slightly to the side (in a non-contracted breast) when reclining, and both look and feel more like a "natural" breast. Thus, round, smooth silicone gel cohesive (not as cross-linked and firm as the teardrop-shaped, "gummy-bear" implants) implants are actually more anatomic than the ones you (and your surgeon) selected.
Did you see an ABPS-certified plastic surgeon? What specialty did her or she train in? Your research should always be tempered and refined by the input of one or more experts in the area of cosmetic breast augmentation (and you must beware of the self-proclaimed "cosmetic surgery" expert). Research your surgeon, and trust only those who pass muster, especially if you are considering secondary surgery! Best wishes!
Using anatomic implants for a short inferior breast crease
It is possible that you would have done better with a round implant but you had a difficult breast condition to begin with and your result is relatively good. You did not mention how long post op your result is but it does take time for the Style 410 to shape the breast.
Here in the states we don't have access to the 410 so I can not pretend to have any experience with them. I think your implants are too high and if your surgeon brought them a bit you would look and feel better. With the gel implants I use, this is a pretty easy procedure that can be done under local anesthesia. I don't think your issue is with the implants themselves. No implant can make up for malposition.
Lisa Lynn Sowder, M.D.
The 410 implants are not released yet
Your issue has little to do with your chose of implants. You had mild ptosis before surgery and you needed more lower pole fullness and your surgeon did not or could not open the lower pole. the use of anatomical implants did not help. You will need revision and implant exchange. 410 silicone implants are not released yet for patient use in U.S
Breast implant options for athletic women
Athletic women have several important issues to consider with implants. Shaped "gummy bear" implants as you have noted can rotate and they are quite firm. With low body fat and muscle activity the implant coverage becomes an issue, along with the potential for animation deformities. Round implants are very often a sensible choice.