Dent above scar line after implant removal 5 years ago - Will a revision fix this? (photo)

Question

Hello! I had my implants (under muscle) removed 5 years ago. Prior to that I had a revision for Symmastia and I’ve had complications since then. Well I removed my implants and now I occasionally have pain when I flex my muscles also I have this indent above my scar line when I lift my arm. Will a revision fix this? Is it scar tissue/adhension? The pain on my pec muscle is it also scar tissue? I did not do enbloc or capsule removal, just removed implants. Thanks!

Emre Guvercin, MD, FEBOPRAS · Answer

Hi there &mdash; thank you for explaining your history so clearly. Yes, this is something we do see after under-muscle implants, symmastia repair, and later explantation, and your observations are very insightful.What is causing the dent above your scar?In your case, this is not just simple scar tissue and it’s not something that can be fixed by revising the existing scar alone.What’s happening is usually a combination of:Excess skin length at the inframammary fold (IMF) levelA mismatch between the lower-pole skin envelope and the underlying tissuePrior internal scarring from symmastia repair and muscle dissectionWhen you lift your arm, the tethered tissues above and the extra skin below create that visible indentation or “dent”.Is the muscle pain related?Very likely, yes.After under-muscle surgery and revisions, scar adhesions involving the pectoralis muscle can cause pain or pulling when you flex. This is common and does not mean anything dangerous is happening.Will a revision help &mdash; and what kind?Yes, a revision can help &mdash; but only if it addresses the real structural problem.The most effective solution is:A longer inframammary incisionA crescent-shaped skin excision at the lower poleThis shortens the vertical length of the lower poleRe-establishes a smoother IMF contourReleases the visual dent above the scarSimply revising or thinning the existing scar will not fix the problem because it does not change skin distribution or lower-pole length.Why this worksBy correcting the excess skin at the IMF level:The breast drapes more smoothlyTension is redistributedThe indentation becomes far less noticeableArm movement no longer exaggerates the defect

Chet Mays, MD · Answer

Thank you for your inquiry!  We would love to sit down with you and discuss your concerns.  Possibly the skin sealed down after the explantation and created this dent.  A scar revision should be able to correct this.  Schedule a consultation with a Board-Certified Plastic Surgeon to help you reach your goals.

Kevin Brenner, MD, FACS · Answer

JustSmile0414-
This area of indentation appears to be scar adhesion down to the chest wall. I have found in similar cases, that fat grafting with subscission...can be a great treatment for this.

Daniel Barrett, MD · Answer

Dear JustSmile0414,
I understand your concern. However, without a proper assessment, it would be difficult to determine what is wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Shaher W. Khan, MD · Answer

Hello, thank you for your question. It looks like you are possibly experiencing some post-explant complications that may be related to scar tissue, adhesions, or residual effects from the implant surgery, particularly given the symmastia revision and the fact that the capsule was not removed during explant. Please see the attached video that discusses your question in detail. I recommend consulting with a plastic surgeon who specializes in breast revision surgery, scar tissue massage or physical therapy might also help in some cases to release tension in the muscles or skin. A capsulectomy could alleviate the pain and improve the contour.

Connie Hiers, MD, FACS · Answer

The dent is because of thin tissue in the area. A fat transfer with or without a scar revision could be helpful. I would try the scar revision first to see if more tissue can be advanced in that area.

Camille Cash, MD · Answer

The contour near your incision could be from scar tissue pulling.  An exam by your surgeon should get you answers to your question.  A small revision should be able to improve this.

Dent above scar line after implant removal 5 years ago - Will a revision fix this? (photo)

Answers (7)

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