What is the best revision method given my BA issues? (photos)

I had my BA 5 months ago with saline 550cc HP with 530 right and 594 Left due to asymmetry in natural breasts with incision through the armpit. I definitely have animation deformity but also feel I am bottoming out. What is your recommendation to fix my issues? The preliminary eval was to perform revision surgery and stitch up the pocket to elevate my implants. And, I want to thank you wonderful Doctors in advance for your time and care on this board!

Doctor Answers 8

Split muscle technique for animation and bottoming out

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Animation deformity is caused by release of the pectoral muscle, and to correct it the muscle needs to be re-attached (behind the implant). The split muscle technique allows for muscle to still cover the upper portion of the implant where it is most important. Bottoming out is corrected with internal sutures to bring up the fold, a procedure called capsulorrhaphy. With relatively large implants such as yours, it may be necessary to add additional support with an internal bra material such as SERI Scaffold, GalaFLEX, or Strattice. You will need to have a new incision as these types of corrective procedures cannot be done through the axilla.

Seattle Plastic Surgeon
4.9 out of 5 stars 59 reviews

Breast Implant Bottoming Out

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You have two issue here. One is that your implants are displaced past your regular fold. This can occur as a result of aggressive lower pocket dissection and large implants size. One of my colleagues has correctly stated that the axillary technique can be challenging and has lost its favor with many of us. For this issue you need tightening of your lower pocket with multiple sutures via a crease incision. The issue of animation distortion is an ever present challenge in sub-pectoral augmentation. Some do not care much about it, but it bothers some women. If this is something that bothers you, my recommendation would be to change your implants to a smaller caliber, place above the muscle, and tighten the lower line of your pocket while doing this. I personally have found that when such revision is done, it is always in the best interest of the patient to downsize the implants. Good luck.

Sepehr Egrari, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 56 reviews

What is the best revision method given my BA issues?

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You have 3 options: 1. Do nothing, 2. Re operate vis a capsularraphy with internal sutures to the inferior pocket, 3. Re operate with use of ACDM mesh to close pocket.. 

What is the best revision method given my BA issues?

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The good news is this is a relatively straightforward procedure, the bad news is that it doesn't always work as effectively as we would like. Unfortunately the anatomic fold at the bottom of the breast was disrupted with the surgery. It will need to be recreated with internal suturing. This cannot be done as well through the armpit so you will need another incision. I find the periareolar approach works best for this particular surgery. While there you can either have the implants converted to in front of the muscle or have the surgeon do some work on the muscle to reduce the animation. Going in front of the muscle will be 100% effective and it looks like you have enough tissue to mask the edges of the implant, but it takes an exam to know that.

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 29 reviews

Double bubble deformity,animation and bottoming out

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The double bubble-animation deformity occurs  with sub muscular implant placement and inferior muscle detachment.
Although it is possible to re- attach  the muscle ,the animation deformity remains.

I therefore prefer to re- position the implant above the muscle and replace the muscle in its original position.

Hilton Becker, MD
Boca Raton Plastic Surgeon
4.6 out of 5 stars 15 reviews

What is the best revision method given my BA issues?

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Thank you for your question and photos. The choice of breast implants and size is determined by your chest wall width, breast tissue base width and tissue coverage over the implant. As it was stated before, it is too bad that your surgeon could not achieve a better result for you. You have two issues going on: 1. you are bottoming out and 2. you have an animation deformity. These are partially due to the large implants that you have. My personal approach to this problem is to deflate your implants (place a needle through the skin into the implant and aspitate the fluid out under local)  and allow your native tissue to rebound. 3-6 month later, go back through an inframammary (IMF) incision and reestablish your normal IMF, place appropriate size silicone gel implants either subglandularly or in a submuscular neo-pocket location. If you decide that you want this done in one surgery, it is very likely that you might need a lift as well. See a board certified plastic surgeon for an in person consultation/examination. Good luck.

Breast implant revision

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Its too bad that you didn't get a better result from the nice starting point that you had. The axillary incision is falling out of favor for many reasons and your experience is one of them.

Your left implant looks reasonable but the right needs to be repaired for bottoming out. This will require a crease incision and multiple internal sutures. I personally wouldn't go straight to a material like Strattice because your tissues have an 80-90% chance of being able to work with sutures alone in my experience. The large size of your implants makes them heavy and increases the failure rate a little. Absolutely don't try to go bigger!!

I think most of the animation artifact will improve with the pocket repair but that should be a secondary goal to the improved look.

Breast implant pocket correction

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Much of the flexion deformity that you see is because your implant has settle inferior to your natural breast crease. Re-establishing the normal breast crease position with a capsulorrhaphy will likely correct both issues. This will be almost impossible using an axillary incision. I would suggest using an IMF incision. Also, you need to understand that your implants are quite big. While there is a chance that a capsulorrhaphy will give you long term results, the fact that your implants are oversized is going to put you at risk for having continued problems with the implant pockets over time.

Wm. Todd Stoeckel, MD
Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 87 reviews

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.