Possile To Have a Defective Gel Implant? One Is Droopy and Hanging 7 Months PO. (photo)

Question

I had cohesive gel implants in July 2011. At 6 weeks, I noticed the right breast was much droopier than the left. I was told this was normal difference and to not be so "picky". Now the right implant "hangs" very heavily, has dropped below the incision line and slid sideways. It is flatter than the right and too soft. It feels like a sack of mud. I still have a lot of pain in the chest muscles on the right. Could it be ruptured? My surgeon pretty much threw a tantrum when I asked him.

	Update 1/9/12

	Since there was ? re:my breasts B4 surgery, here is a picture. My breasts had sag and loss of volume, but they were symmetrical and pretty. At 7 mos PO, I have a sagging, displaced implant and constant chest pain. When I lay down I can feel the implant rolling to the side of my rib cage, and has dropped even more in the last few weeks. I was calm when I asked my surgeon about this; he was instantly angry and defensive. I am paying OOP for an MRI to R/O rupture. I don't know what else to do.

Richard H. Tholen, MD, FACS · Answer

Tatiana, thanks for the photos and detailed description. You have accurately described your asymmetries, but have come up with an entirely incorrect "reason" for what you see.

	You have focused on your right breast as having the problems, and obviously prefer the feel and appearance of your left breast. It does appear as if your right breast lift may have been slightly "looser" than your left, but by your photograph and description, I believe you may actually have a capsular contracture on  your left side, whereas your right breast pocket is not contracted, making it feel "soft, squishy, and like a sack of mud." I believe you meant to type your right breast is flatter than the left, which also goes along with some degree of capsular contracture on your left side (or at least a smaller submuscular pocket).

	It is extremely doubtful your implant is ruptured, but a "tantrum" is a pretty colorful term for your surgeon's response. I am sorry if one of our colleagues has responded to you in this way, as your issues are real, correctible, and pretty "standard" for a full breast lift plus implants in a fair number of patients. If your surgeon is unwilling to discuss the revisional surgery that is recommended to address your concerns and improve your symmetry, you may need to see one or more other ABPS-certified plastic surgeons for advice.

	You may also want to be prepared for advice about surgical revision on the left side in addition to, or perhaps instead of, surgery on the right, since soft is more natural, even though higher, tighter, and more "perky" can be an unwitting outcome of capsular contracture on your left side. The best compromise in your case may be additional skin reduction (tightening) on your right side, possible capsulorrhaphy (internal pocket sutures to tighten the pocket), and perhaps a higher profile implant on that side if you are adamant about not releasing what is actually unnatural firmness in your left breast.

	Unfortunately, unless you wish to travel to Europe to see my friend Dr. Verpaele, polyurethane-covered implants are no longer available in the US, but can indeed minimize the recurrence of capsular contracture in appropriate cases. The presently-available cohesive gel implants (by either manufacturer here in the US) are excellent products that are exceedingly durable and cannot leak and rarely rupture (would require a major force such as a car crash or severe injuring blow to the chest). This is NOT an implant issue, it is a tissue issue (sorry). Good luck and best wishes!

Kamran Khoobehi, MD · Answer

You may have capsular contracture which is very common post implant replacement for ruptured silicone implants. I do not think you have ruptured implant. You left breast has capsular contracture and that is the reason for the firmness. The other issue is the excess skin over both breasts and possible need for lift revision.

Darryl J. Blinski, MD · Answer

Great question and posted photos. Very hard to determine the causes. Best to return to your surgeon request MRI of breasts. Either you have a rupture of the right vs a capsular fibrosis of the left. The best non invasive examine is the MRI. Please lets us know the results and outcome.

Alexis Verpaele, MD · Answer

Dear Tatiana,

	thanks for so nicely documenting your problem. I guess you took the pictures in the mirror. Most likely your right implant indeed is sitting lower and more to the side than the left one, but I have the impression the lifting has been done tighter on the left hand side as well, which emphasizes the asymmetry.

	My solution to this problem would be to replace the implants with polyurethane covered ones, which adhere almost instantly to the surrounding tissues, ensuring a very stable position in all directions. Unfortunately these implants are not available on the US market.

	Another good solution would be to reposition the implant in a higher and more central position, and to perform a "capsulorrhaphy", which is to reduce the pocket size on the side and below as to force the implant in a better position. I would also suggest to make the lifting on the right side a bit snugger.

	Hope this advice is helpful to you.

Steven Wallach, MD · Answer

Based on the middle picture, I would say that the breasts look within reasonable position. Yes, it is slightly lateral and if one wants to be picky you can say so, but to adjust that even with suturing techniques may not completely adjust that long term.

Possile To Have a Defective Gel Implant? One Is Droopy and Hanging 7 Months PO. (photo)

Answers (8)