size 34 C, 400 cc implants will produce a DD.
400 cc implants weigh approximately 1 lb and your deformity is the result
of over implantation. Your skin envelope
is unable to hold the weight, has drooped inferiorly and laterally requiring
revision. I recommend a new technique
called Implant Exchange with Mini Ultimate Breast LiftTM. Using only a circumareola incision it is
possible to reshape your breast tissue creating upper pole fullness, elevate
them higher on the chest wall and more medial to increase your cleavage. Aligning the areola, breast tissue and
implant over the bony prominence of the chest wall maximizes anterior
projection with a minimal size implant.
Small round textured silicone gel implants placed retro-pectoral look
and feel more natural, are more stable, less likely to ripple or have
complications needing revision. Implant
profile is irrelevant in the retro-pectoral position since the muscle
compresses it. 22% of women who undergo
breast augmentation alone require revision within 2 years because they are
dissatisfied with the result. Frequent
causes of dissatisfaction are over implantation and not performing a
simultaneous lift when needed.
Gary Horndeski, M.D.
You may have implant positon issues with a double bubble only when raising arms. As for the rippling that happens when the soft tissue envelope thins out. Sometimes Strattice is used to help the rippling and pocket issues as well. Best to be seen in person.
There are several issues to sort out with the type of problem you describe, and ultimately only an in-person exam would be required to get useful advice. The picture with your arm raised does appear to show a double contour above the crease. If this pulls up when you flex your pectoral muscle, then it is also an animation issue due to the muscle pulling on the scar capsule. If that is the case, then both problems could be fixed by converting to the split muscle plane. However, there is also some sagging of the lower portion of the breast even though the nipple are in the correct position; this is known as "pseudo-ptosis." If it is due to the implant and not the breast tissue, then the cause is what we call stretch deformity and can be fixed with capsule revision, possibly using an internal bra material such as SERI Scaffold or GalaFLEX mesh. If due to breast tissue, then a lift is the way to go.
Thank you for your question and photos. From the photos you provided, it is difficult to tell of there is a true issue. An in-person exam is most helpful. You may have some mild capsular contracture around the implant as evidenced by your photos with you leaning over or raising your arm, but as far as double bubble or bottoming out, this is not evident from your photos. Best advice is to see your surgeon who can perform an exam and help put your mind at rest.
I'm sorry to hear about the concerns you have after breast augmentation surgery. Unfortunately, it is not clear to me what is going on based on your photographs alone. This will best be determined upon physical examination; you may wish to return to your plastic surgeon for more precise advice then you will be able to receive online. My best guess based on your description and viewing photographs is that you may be dealing with breast implant displacement inferiorly and that revisionary breast surgery may be helpful to you, if this is the case. This type of procedure will not be covered by insurance companies. Best wishes.
Sometimes it is difficult to accept you have a nice result, this is a realistic expectation concept.