I think a revision including the use of ADM, repair of your IMF, and a revision of the mastopexy and possible fat grafting would be helpful. Also, the size of your implant is a problem and you might want to consider removing some of the saline from the implants. All of that weight is going to make any repair much more difficult.
Fat transfer alone will not fix the problem
I am sorry that you are having issues with your augmentation. You implants were too big for your breast tissue and your inframammary fold is disrupted. You will need to downsize your implant, breast lift revision and fat grafting.
In my practice, this can usually be corrected with a mastopexy/implant revision with the addition of fat grafting. A less invasive approach is to try solely fat grafting but based on your third picture I think you need more of a revision. Best wishes.
Fat grafting or IMC repair for Double Bubble.
In my experience this deformity occurs from the implant settling too far below the natural IMC as a result of efforts to place a large implant. It's difficult to know during surgery if the deformity will occur. My recommendation is to consider a capsulorrhaphy and possible exchange to smaller implants. Some people use external sutures, I choose internal sutures with 6-8 weeks of external support.
Good luck and best wishes.
Jon A Perlman MD FACS
Extreme Makeover Surgeon ABC TV
Certified, Am Board of Plastic Surgery
Beverly Hills, Ca
How to fix an animation deformity
From you pictures I might offer both. It may be difficult to get the cut end of the muscle back down to the infra-mammary fold. Its much easier to do it with your fingers than on the inside. A piece of alloderm or similar may be needed, and possible fat grafting over the entire area. Its hard to know without an actual exam.
Eric Weiss MD
From the photographs you have included, if you are my patient, I would recommend a contour three piece of Stratus with with complete the section of the overlying practice muscle in order to suture the bottom of that muscle to the Stratus and then the bottom of the Stratus to the infra-mammary crease in the correct position elevated from where it is now. The animation deformity will remain unless the muscle issue is addressed. Never having seen a 900 mL implant in 25 years of practice, Concert I don't know if the largest piece of Stratus would even work. Good luck.
Do I need a fat transfer or inframammary crease tucked?
Without in person full examination I might offer fat grafting with rigotomies to the double bubble deformity.
Fat transfer vs IMF inset.
Thank you for asking this question. You are describing clear signs of an animation deformity due to the implant position and pec muscles. A thorough physical exam is the only way to know how to best address these issues. Fat grafting may be used to camouflage subtle abnormalities but you seem to have a sizable deformity. I would consult a few surgeons and have a plan that makes sense prior to undergoing surgery.
Theodore T. Nyame MD