Permanent Sutures for Breast Implants Pushed out to the Side?

Breast revision surgery can be very complicated without guaranteed results. As far as the deformity you have with muscular contraction, that is the result of having the implant under the muscle. You are very thin and already have rippling, so I dont think it is an option for you to have had the implants placed in front of the muscle. That is the only way to avoid the "animation deformity".
You are having bottoming out and the implants have gone to the side, so you need what is called capsulorrhaphy. Meaning suturing the lateral pocket closed and the inferior pocket closed to help the bottoming out. In these instances to make this work your have to be very diligent and wear an undewire bra all the time. You will probably need to go maybe a little smaller to decrease the weight of the implant and switch to silicone to decrease the rippling, but not eliminate.
Hope that helps.

Thank you for your question!  Given your history of failed attempts at revision to correct symmetry and shape issues, consideration for either an acellular dermal matrix or mesh-type substitute is reasonable.  A capsulorrhaphy would be needed for revision of your breast pocket. If you do need such, the use of a dermal matrix or mesh may be considered if your tissue now has significant laxity that is failing in support or a significant deformity in which recreation of the breast pocket is required along with adding additional support and coverage of the implant.  Certainly, the larger the implant, the heavier the weight...thus, it may be useful to consider placement of a matrix or mesh. Otherwise, capsulorrhaphy for pocket revision using your native tissue should suffice.  It has been used safely and effectively to correct synmastia, restore the inframammary fold, mask implant issues (e.g., rippling, wrinkling, etc.), and improve aesthetic results in revisionary breast implant and reconstructive procedures.  However, only by physical examination would one be able to make recommendations on the benefits over the risk of using a matrix or mesh in your situation. Consult with a plastic surgeon well-versed in breast procedures and the use of dermal matrices and mesh in breast procedures who will assist you in determining which procedure(s) would be the best for you.

If you are already rippling on the sides, the last thing you should do is go in front of the muscle. That would risk rippling all over. Maintain as much tissue coverage as you can!
You do need to have a lateral capsulorraphy, which means closing off the outer pocket. BUT, you must understand that pockets can passively widen due tot he stretch of your tissues over time. But it shouldn't get to the point that it is deforming. My point is to emphasize to you that there is always a drift of implants to the side over time.
I disagree with those who told you not to exercise. That's as silly as when a doctor says to "breathe normally." You should be able to do every activity you want after breast augmentation.
You do need to go smaller, however. At 5'2" and 104lbs, your implants are undoubtedly too large for you and fundamentally the cause of your problems. While silicone ripples less than saline, it still can ripple. The reason you have a rippling problem is that you have large implants under thin skin. So you need a smaller implant, and you are better off with silicone.
Good luck. And remember....don't have your surgery done by someone who just tells you what you want to hear. you need to do what is right. Accept that you need to go smaller!

All the other surgeons have made excellent comments here that do not need to be repeated.
However, I would strongly advise avodance of exercises that result in pectoralis major contraction. This generally inculdes: bench press, wide stance push ups (narrow stance are ok) and the "pec dec" or butterflies. You will be able to build up all the surrounding muscles without truly effecting your routine.

The problem you describe is a very common one in muscular women, and something in which I have a special interest. Every time you flex, the muscles push the implants apart and down, and whether the sutures are permanent or not this will continue to occur. You can prevent it by going above the muscle but then the rippl;ing is worse. One technique I have had success with is a variation on the subfascial technique called the split muscle technique. Here are some resources to check it out: http://www.drbaxter.com/corrective_procedures.html, and http://www.drbaxter.com/breast_implants_athletic_woman.html.
I hope this helps, I can also put you in touch with a paytient who has had this done.

Rippling and implant displacement are avoidable. The issues of visible rippling, and displacement of the implants down and out are related to implant placement.
The most common "submuscular approach" is really only a partial coverage of the implant by the pectoralis major muscle. The muscle covers the implant above and to the middle, wheras the bottom and side have no muscle coverage. It is because of this absent muscle coverage that the implant can be displaced to the bottom and side. It is also because of the lack of muscle coverage that rippling is seen on the side rather than above, where it is more commonly seen in patients with implants placed above the muscle.
I prefer elevation of the muscles distally and laterally to form a sling for the lower and lateral aspects of the implant. I have a video illustrating these points with anatomical drawings to help you understand the issues of rippling and muscle coverage at the link below

Hi naturelover. You describe several issues. First, many patients have rippling on the lateral sides. This is where we have thin tissue overlying the implant and thus this area is prone to visible rippling. Silicone implants ripple less than saline but they still ripple. The deformity when you flex happens in some patients and can only be corrected in my experience by placing the implant on top of the muscle. If you are very thin on the upper, inner aspect of your breast, as in you have very visible ribs in this area, you are at risk for having a visible edge of the implant if the implant is placed on top of the muscle. However, silicone implants are more compressible than saline and thus visible edges are usually less of a problem. Without pictures it is hard to know if you are a candidate for above the muscle implants. There are other things to consider as well when choosing implant position. Bottoming out and lateral displacement can be difficult to correct. Sometimes a new pocket makes a big difference. Permanent sutures can help also. I find in a lot of my patients that using Alloderm or Neoform to reinforced the lateral and inferior pocket can really help. Make sure your board certified plastic surgeons performs a lot of breast revision surgery as it can be tricky. Hope this helps.
Tracy M. Pfeifer, MD, MS

Your secondary revision should include implant exchange, revision of the infra mammary fold and the lateral breast fold. This could be done with sutures but also ideally with a sling of dermal substitute( like alloderm). This will act as a strong hammock that will prevent future sagging. It crucial in revision surgery to have a clear operative plan to avoid any future revisions.Since you are already under the muscle ,pocket exchange might not be very helpful. Muscle splitting will not help be helpful but could weaken the muscle support. Hope that helps!

the deformation may occur anytime the implant is under the muscle, and you can't guarantee that it wont.
Ripples may be due to the saline implant, or scar tissue bands that form in the capsule and hence deform the implant.
Regarding the bottoming out and lateralization of the impalnt. Your muscles may be the reason, or the initial dissection may be the reason, or weakness of the tissue may be the reason, no one can really tell. Permanent sutures along with your own scar tissue will form a strong repair. Again no guarantees.
As another consideration, you may have the implants removed, or consider placement over the muscle.
sek

Placing silicone implants in may help with the rippling. Alloderm can also help TIghtening the pocket to fix the displacment of the implants may also help.