Need Breast Revision + Lift Currently over + Saline 300cc Considering Silicone...drs Want to Go Under I'm Not Clear Why? (photo)

18yrs ago I had 1 side expanded then implants. I now have a leaking saline implant. Currently placed sub-mammary, tuberous breasts, asymmetry, likely need lift on at least one side, uneven infra-mammary folds/lower pole restriction? and also high placed "smile" under breast incisions.

Doctor Answers 14

Need Breast Revision

If the left side alone were the sole issue here, I would concur with you about questioning a pocket change. However, the issue of capsular contracture on the right side complicates the decision process. Most surgeons would suggest repositioning to the submuscular plane the implant on a side with a capsular contracture, to reduce the chances of another one.

As to the lift, I don't see a "need" for one on the right, and if the left looked about the same before deflation, I would feel the same about that side. 

Getting a number of opinions seems worthwhile, and then you will have a tough time deciding among alternatives that will be proposed. All the best. 

Seattle Plastic Surgeon
4.6 out of 5 stars 45 reviews

Best Breast Operation for Me?

Thank you for the question and pictures. Assuming that you are happy with the look and feel of the breast uninvolved with the deflation, I am unclear as to why a breast implant pocket exchange is “necessary”.  In other words, after reading your concerns about a breast implant pocket exchange, I think you'll likely do well keeping the current breast implant pockets being used during your revisionary breast surgery.

 As you can imagine, more precise advice would necessitate in person consultation.  As you go through the consultation process don't hesitate to ask your plastic surgeon consultants about the reasoning behind their recommendations. Communicate your goals clearly also.

 I hope this, and the attached link, helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,488 reviews

Over vs. Under the Muscle

There are some studies that report a lesser incidence of firm #capsules with #placement behind the pectoralis muscle. If you developed firm capsules and your implants were submammary (behind the breast tissue) then conversion to a submuscular position should be considered. This placement is particularly better for the very thin patient who has little breast or fat in the upper part of their chest. In most circumstances, those patients with ptosis (#sagging) require placement above the muscle in a #submammary position or under the muscle combined with a #mastopexy (breast lift) for contour purposes. The best method and #technique for your #procedures will be discussed in greater length during your one-on-one consultation with a board-certified plastic surgeon.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 109 reviews

When a mastopexy and a breast augmentation are done concurrently sub pectoral placement of the implant is probably safe.

Because the blood supply issues to the breast tissue went to operations such as breast augmentation and mastopexy are performed, it probably is safer to place the implants below the pectoralis muscle in avoid violating chest wall perforators which a sub glandular placement would.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.7 out of 5 stars 35 reviews

Explant with Mini Ultimate Breast Lift

You need Explant with Mini Ultimate Breast Lift.  Using only a circumareola incision it is possible to reshape your breast increasing upper pole fullness, elevate them higher on the chest wall and more medial to increase your cleavage.  Through the same incision, the old implants are removed and the new implants placed.  I recommend silicone gel implants placed retro-pectoral since they look and feel more natural and are less likely to ripple.  This technique also elevates the inframammary fold.  Aligning the areola, breast tissue and implant over the bony prominence of the chest wall will give maximum anterior projection with a minimal size implant.  Smaller implants will descend less, are mor stable long term and less likely to require revision.

Best Wishes,

Gary Horndeski, M.D.

Gary M. Horndeski, MD
Texas Plastic Surgeon
4.6 out of 5 stars 223 reviews

Breast Revision

Thank you for including photos with your question.  It appears that bilateral implant exchange with submuscular conversion in addition to right capsulectomy would be indicated.  Submuscular implant placement is preferred for two reasons: 1. this decreases the chances of capsular contracture due to the "massaging" action of the muscle over the implant and 2. the advantage of "seeing" all mammary tissue on mammography.  The advantages of silicone gel implants are that they more closely resemble natural breast tissue and if they do leak, it would not result in a "deflated" appearance.  Breast lift depends on the grade of ptosis (sagging) present, which is difficult to discern on the right side due to capsular contracture.  It would be advisable to have a consultation with a Board Certified plastic surgeon who is experienced in dealing with the complexities of Tubular Breast Deformity.

Mark Deutsch, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 32 reviews

Need Breast Revision + Lift Currently over + Saline 300cc Considering Silicone...drs Want to Go Under I'm Not Clear Why? (photo)

        At the very least, going under the muscle creates more camouflage for the implant and decreases the chance of rippling. However, maintaining the pocket would certainly be easier for the surgeon. Kenneth Hughes, MD Los Angeles, CA

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 492 reviews

Need Breast Revision + Lift Currently over + Saline 300cc Considering Silicone...drs Want to Go Under I'm Not Clear Why? (photo)

With your many concerns I recommend a STAGED operative approach. First exchange to UHP silicones in 375 to 400 cc range. Allow 3 months healing and I could keep in same pocket if that is YOUR desire. Than consider lifting in a second operation. 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 173 reviews

Capsular contracture and pocket change

Because you have  a capsular contracture, it is usually preferred to place implants in a submuscular pocket to reduce the risk of another capsular contracture.

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

Breast Implant Revision

Thank you for the photos.  If your saline implant has leaked then the shape will be different so a lift may not be necessary.  I see no reason why you can't get silicone implants in the same pockets .

Dr. ES

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.