Breast Augmentation - Revision or Remove and Replace? (photo)

Surgery 3 1/2 years ago with Mentor implants, gel filled, smooth round moderate profile, placed submuscular. 325cc on the right and 400cc on the left. I'm 145 lbs, 5'8" and was a 36 A and now in a 36 C bra size. Is there a procedure that you would recommend to make the breast look more balanced with each other? Also, if I wanted to have a more natural feel to the breasts, would having them repositioned in a dual plane techinque achieve that goal? What about going w/larger implants?

Doctor Answers 11

Difficult case

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It is impossible to give you agood advise after only looking at pictures, however:

It looks like you have capsular contracture, hence the hard feeling of your breasts, in general the only treatment for this is capsulectomy and exchange of implants, with capsulotomy there is a high chance of recurrence.

Left side is bigger than right, that is obvious on the pictures and you know you have different size implants.

The implants appear to be in the subglandular position ( I noticed you mention there are submuscular) during physical exam it will be obvious if there are submuscular, hopefully that is the case and changing the implants to a submuscular plane will give you a better chance of much better results.

Implants are too high, this could be because of the capsular contracture or because the surgeon left them too high, you may still need a breast lift to improve the location of the nipple/areola. Probably will be better to decide for this after a implant exchange/capsulectomy.

Be sure you choose a American Board of Plastic Surgery  certified surgeon for your future surgeries.

Kansas City Plastic Surgeon
5.0 out of 5 stars 31 reviews

Implant Revision for uneven breasts

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Your photographs show that the vertical height of your breasts is greater than the horizontal width.  Your alternatives are to decrease the size of implants that will decrease the vertical height or have additional lateral (outer sides) dissection to increase the width.  Certainly, you could not undergo any medial dissection as they would be touching.  The second problem you have is your nipples are not centered on the mound, particularly the right breast from your lateral photographs.  You will need a donut mastopexy to center the nipples over the mounds.  I recommend smaller implants instead of additional lateral dissection and use the eccentric donut to center the nipples. If needed, at the same time, the breast tissue that has descended down and out can be repositioned.

Best of Luck.

Gary Horndeski, M.D.

Gary M. Horndeski, MD
Texas Plastic Surgeon
4.6 out of 5 stars 230 reviews

Breast Augmentation Revision?

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Thank you for the question and pictures.

Yes, I think you will benefit from revisionary breast surgery. Your current breast implants  seem to be too high on the chest wall and the nipple areola complexes too low on the breast  mounds. I think by opening up the breast implant capsules and lowering the breast implants you will have a better balanced/centered look;  this should also achieve a softer appearance/feel of the breasts.

Physical examination will be very helpful in determining other options...

Best wishes.

Implant issues

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Usually placing them under the muscle in a dual plane position gives more soft tissue coverage.  Your implants look too high.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Breast revision, remove, or replace

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Your implants are high and not centered in the breast, and the cover is quite thin. Your photo does not look like you have a submuscular breast implant and an exam would confirm. A larger implant could mean even larger problems, though a revision would help as things don't look 'right'. You might see a different surgeon.

Best of luck,

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

You will need pocket revision and moving implants lower and lateral

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Your implants were placed too high and too medial. You will need pocket revision and dual plane will help. I am concerned about the depression over the sides. Your implants are above the muscle even though you stated that they are under the muscle. Your breast tissue can not handle bigger implants.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.8 out of 5 stars 154 reviews

Revise Breast Augment With Dual Plane Implant Placement

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You must be doing your homework. You're the first patient I have ever heard use the term "dual plane." Based on your photos it looks like the two implants are too high up on your chest. I saee that sometimes when the patient has not had adequate release of the pectoralis muscle. The lower muscle edge acts like an internal sling support.  I don't see mention of the original incision location, but most of the time when a patient comes to the office with that look it was done with an axillary (armpit) incision. I have found we get very nice results by using either a PA or IM incision to release the front surface of the muscle from the overlying breast tissue allowing the muscle to slide a little ways up the chest and it takes that sling effect away. The lower pocket will need to be redissected so the implant can "fall" into it.

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

When to replace breast implants in revision

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The answer of course depends on what your specific concerns and problems are, and would require a personal evaluation but with that in mind here is what I see: Implants too large relative to the base dimensions of the breast. Because the distance from the nipple to the bottom of the breast is much shorter than to the top, lowering the implants to center them behind the nipple would require lowering the bottom fold of the breast. This could cause a double bubble which would be substituting one problem for another one. Better to replace with smaller implants for a more natural look.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 59 reviews

Breast Implant Revision/Replacement: fixing previous breast augmentation

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When a previous breast augmentation result does not give the ideal aesthetic and sensual result, the best option is to revise the breast "pocket." This allows a trained plastic surgeon to recreate the natural borders of the breast.  In your case, redefining the sensual contours of your breast will allow for a better and more appropriate implant position.  This will accentuate and complement your trim physique and restore the aesthetic and sensual curves of the entire body.  By refining the submuscular layer and the inferior fold, I am confident you can regain an outstanding result.

John G. Apostolides, MD, FACS
La Jolla Plastic Surgeon
4.9 out of 5 stars 29 reviews

Implants are too high...

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The biggest issue that I see are that the implants are too high on the chest wall, giving more fill on top and minimal fill on the lower part. A dual plane approach may help, but a release of the lower pocket would essentially accomplish the same thing. I don't believe larger implants would be of much help unless they were lower on the chest. Good Luck.

Brian Klink, MD
Vacaville Plastic Surgeon
5.0 out of 5 stars 100 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.