Breast Pocket is Misshapen Due to Rib Placement? (photo)

my 1st BA was in June and right side did not descend. 2 wks ago had pocket revision. Natural right breast was smaller and higher than left. now there is a dent at 7-8 o'clock and implant is poking through. dr told me that my rib isn't in the right place so the muscle keeps attaching upwards and keeping the fold from being round. she says worst case scenario is a 3rd surgery to create a sling with dermaplane using mammary fold incision. what are my options and can a rib prevent a normal result?

Doctor Answers 11

Breast Pocket is Misshapen Due to Rib Placement?

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Looks like capsular scar fibrosis in the left inferior-medial quadrant. Easy solution is fat grafting. 

Breast Pocket Not Tailored To Fit The Implant Correctly

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Thank you for sharing your photo.

Usually, the anatomical positioning of a rib may not lead to a pocket deformation hence the dent shown on your left breast (assuming that the photo was not a reflection off of a mirror).

With that perspective, to redesign the pocket you will have to undergo a 3rd surgery for the correction to be made. 

That being said, please remember that commendable results require an exceptionally skilled surgeon to perform the surgery and settling for anything less than that increases the chances of additional corrective surgeries dramatically.
I hope this helps and please feel free to check the website below.

Thank you for your inquiry.
The best of luck to you.

Dr. Sajjadian

Ali Sajjadian, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 205 reviews

Unlikely rib problem...

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While it is possible that asymmetries of your rib cage could lead to positioning issues and differences in the appearance of your breasts, this explanation is not plausible.  The left breast implant poking out at 7-8 o'clock is due to the way the pocket was dissected.

It's very difficult to help you given the photographs you've posted but the problem could probably be resolved by "redoing" the breast fold (inframammary fold) either through an areolar or mammary fold incision.  You don't necessarily require the use of materials commonly used for reconstructive procedures but its always an option when everything else has been attempted.  Good luck... 

Eric Sadeh, MD
Manhattan Plastic Surgeon

Breast Pocket is Misshapen

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I am not sure I understand your report of what your surgeon stated.

Based just on the photo, it appears that the pockets are not even, and that opening the pocket in what appears to be the left side form the 6 to 9 o'clock position should correct this. 

Only an actual exam should determine what is done. If you feel uncomfortable with your surgeon's explanation, seek a second opinion.

Thanks and best wishes.

Jourdan Gottlieb, MD
Seattle Plastic Surgeon

Indentation after breast augmentation and revision.

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Asymmetry in breast are often difficult to correct especially if there is chest wall differences from side to side. It is not clear which side was revised but the rt breast looks good the left side will need better release on the 6 to 8 o'clock location. Good luck. 

Irregularity after breast implant revision

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Perhaps the photos came through reversed, because the area of irregularity appears on the left breast in the photo I am looking at.  Also the bruising on the left side suggests recent surgery.  You might want to try implant exercises in which you put a sustained pressure on the outer aspect of the implant to stretch out the area of indentation.  If this doesn't work you may need another surgery.

John Q. Cook, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 12 reviews

Breast Implant Asymmetry Due To Inadequate Pocket Dissection

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The concept of rib location being a contributing factor in good breast implant pocket location is not an accepted breast augmentation problem. I would suggest that you get a second opinion as the higher breast implant location indicates that the pocket has merely not been released enough in that area. There are still muscle attachments to the rib that need to be released. (perhaps this is what she meant) While this can happen after any primary breast augmentation, it usually is a straightforward problem to resolve in a revisional procedure. 

Indentation along lower chest

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The indentation in all likelihood will not get better with time.  You may need further release of the are to improve the shape. You may want to seek a second opinion.

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

Pocket Irregularity

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I am sorry you are having this problem.  Based on what you've said your surgeon told you makes me think that you should visit other surgeons.  Please be sure that they are highly reputable for all types of cosmetic breast surgery, not just implants. A minimum requirement is certification by the ABPS and membership in the ASAPS.  You will need another surgery unfortunately.

Best of luck.

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 100 reviews

Breast “Indentation” after Breast Augmentation?

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Thank you for the question and picture.

Although it is not possible to provide you with precise advice without direct examination, I would agree with you that it is very likely that additional surgery will be necessary to improve the contour of the involved breast. However, I would suggest that you seek additional opinions;  it may very well be that additional work on the medial aspect of the involved pocket will help improve the contour of that breast.  The downside to additional surgery may be that you  may be able to feel the breast implant more so in the “rounded out” area that he do now;  this will be the trade-off for an improved contour/shape/symmetry.

 I hope this helps.

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.