Breast Augmentation - What Went Wrong?

hi everyone, i had a breast augmentation 5 months ago but very unhappy with the result... i was an empty 32b (uk, not sure if it the same) had 340g dual plane implant could you please tell me what you think has gone wrong and what would be the sest solutions?

Doctor Answers 8

Nothing Wrong, Except...

The implant surgery appears to have gone well, and the result is what you would expect from the approach taken.  When there is significant breast ptosis like you have, an implant placed under the muscle, even partially, does not give an ideal result.  Here are your 4 best options for your breasts:

  1. Mastopexy (breast lift) alone
  2. Mastopexy/augmentation together with subpectoral implant placement (smaller implant)
  3. Mastopexy alone followed by augmentation-2 separate procedures (subpectoral placement & larger implant)
  4. Augmentation alone, submammary placement (saline or silicone, silicone preferred)

The choice depends on YOUR desires for shape/size/scars/cost/recovery time.  It appears you would have been fine with just a submammary implant, it is very straight forward to remove your current implants and reposition them in a submammary pocket.

Good Luck,

David R Finkle, MD

Omaha Plastic Surgeon
4.9 out of 5 stars 75 reviews

Implant selection and subfascial placement for natural appearing breasts

There are two things that create the undesirable aesthetics.  Firstly the implant base width appears to be too narrow for your chest wall dimensions.  Secondly you have undesirable lateral inferior stretchning that is very common with dual plane placement.  Placing breast implants under the muscle creates a few aesthetic problems. If you look at your picture, your breasts are too far apart at midline to have a natural appearance.  any time your arm moves this appearance will widen and worsen.  This is the reult of releasing the inferior portion of the pectoralis major muscle.  The more superior origins will not allow the implant to sit in a natural place and the continual forces of the muscle constantly push the implant down and out.  When this is combined with excessive undermining of the inframammary fold, the deformity that you are seeing results and continues to progress.  This is a very common finding with submuscular placement.  To understand these forces better, stand in front of a mirror topless, put your hands on your hips and push down onto your hip bones firmly.  You will see both breasts move down and out.  these forces over time always cause lowering, lateral displacement, thinning of the breast tissue and stretching of the skin.  This is the reason that I use a unique technique in my practice called 'cold-subfascial augmentation.' THis technique leaves the muscle alone and out of the equation but should not be confused with 'above the muscle' which I would also not recommend.  The cold-subfascial augmentation harnesses the strong structural power of the pectoral fascia to create a truly natural breast shape and act as a living structurally sound brassiere inside the breast protecting the breast from the pressure of the implant and forces of gravity.

I have seen many patients with identical problems to the one you present and in my opinion there is only one good solution- changing placement to a new cold-subfascial plane.  All of the native inferior support of your breast is now violated and conventional techniques like capsulorrhaphy and neosubpectoral placement rely on structurally unsound scar that will surely stretch and recur.  There are several mesh and biological products people use to restore support but these in my opinion do not offer lasting support or add new risks or unnatural feeling/appearance.  In my experience, revising breasts such as yours with a subfascial plane can create a more beautiful and lasting augmentation then your original before the problems started.  I hope this helps!  

All the best,

Rian Maercks M.D.

Rian A. Maercks, MD
Miami Physician
4.9 out of 5 stars 73 reviews

You needed a lift is what went wrong

Even though your photos are not surgical standard I can see that both breasts were droopy preop, left worse than right.  The implants actually look to be in good position and have just magnified the asymmetry you had all along.  You need lifts to get a more youthful look and better symmetry.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
4.8 out of 5 stars 67 reviews

Breast lift may be required

It appears that you may have benefited from a lift prior to your surgery, and breast augmentation alone has magnified the natural droopiness of your breasts. You may benefit from a  breast lift, however please see an experienced board certified plastic surgeon for a physical examination.

Jerome Edelstein, MD
Toronto Plastic Surgeon
5.0 out of 5 stars 176 reviews

What went wrong?

Not being privy to your conversations with your doctor it's hard to talk about right or wrong.  There are different approaches and they each have advantages and disadvantages.  Looking at your pre-op photos you do look like someone who is a candidate for a breast lift.  Another option would have been to place your implants over your muscle. Both of these scenarios would give you some assistance with your concerns but do carry with them other issues to consider- cost, scars, capsule contractures, etc.  The 'dual-plane' technique does have the ability to provide you with the appearance of some lift while still keeping your implants under the muscle.  In your case, that was the only choice if, indeed, you were against having a lift.  In that case, the result you have is quite reasonable.  Not ideal.

Scott E. Newman, MD, FACS
New York Plastic Surgeon
4.9 out of 5 stars 42 reviews

PHOTOS: Breast Augmentation - What Went Wrong

One surgeon's advice: It appears your left breast was lower to begin wtih. At this point it looks to have settled below your crease. You may require left sided capsulorraphy and/or  nipple lift and possible volume reduction

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 81 reviews

What went wrong?

From the photos you provided, I would agree that it is very difficult to assess what is going on, if anything.  As Dr. Wallach commented, your arms are in different positions before/after which will naturally change the appearance and position of your breasts.

As with any surgery, the best person to comment on your results is the surgeon who actually performed the procedure.  A discussion of expectations of what you expected and what actually resulted should be held and then you two should decide how to proceed from there.  In addition, it sometimes helps to get a second opinion from another surgeon locally.

I hope that helps!

Gregory A. Buford, MD, FACS
Denver Plastic Surgeon
4.9 out of 5 stars 42 reviews

Breast augmentation

While the photos are helpful, they are not standard, and your arms are down in the pre-ops and up in the post-ops.  It looks like you could use a small lift of at least the areola in the photos more so on the lef.t

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 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.