Can you advise on under muscle revision with new pocket? (Photos)

Question

Total capsulectomy with implant exchange. 300cc silicone implants over the muscle replaced with 450cc implants in same pocket Implants replaced after 18 years. There was no revision to the pocket. He decided against a breast life during surgery saying that I didn’t need one.. I am not happy with the results. I want a revision under the muscle with a brand new pocket.

Paul E. Chasan, MD, FACS · Answer

Thank you for your question.  A large portion of my practice is dedicated to revisionary breast surgery.  In your case, you have the classic signs of "slide down" associated with implants placed on top of the muscle.  I actually wrote the only paper written describing repositioning of the implant from a subglandular position to a submuscular position.  This is almost always associated with a breast lift.  You are an excellent candidate for this.  Best wishes to you.

Ronald J. Edelson, MD · Answer

I agree you do not need a lift. Your implants have bottomed out a little and it could be revised.  I'm just not sure that it would be worth it from a cost perspective. Only you can decide if the cost is worth ut

Daniel Barrett, MD · Answer

Dear Kirsty1985,
breast revision surgery is the most difficult plastic surgery procedure performed. Botched breast surgery alters normal tissue planes and laxity, the ability of breasts to heal properly, and leaves scar tissue that dramatically affects the level of difficulty of the corrective surgery.Many patients come in to correct poor outcomes from their initial surgeries. The most common problems are due to implant malposition, bottoming out of the implant, poor scarring, and incorrect implant size.While the type of revision required will depend on the result of the previous surgery and the desired result of the patient, some revisions involve extensive pocket repair that may or may not need specialized external bras.If you are considering breast surgery revision, you should speak with a board certified plastic surgeon and have yourself properly assessed. Only after a thorough examination you will get more information and recommendations. Also, you have to make sure that your surgeon understands your breast augmentation goals
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

William T. Stoeckel, MD · Answer

Not sure about the question. But your breast implants are slightly bottomed out with the lower pole of the skin envelope being stretched over time. They do not look perfect, but they are symmetric and you do not have mastopexy scars. You can certainly change the position of the implant and elevate the implant on the chest wall and place them under the muscle. You would need a mastopexy at that point to allow the skin to drape around the implant properly.

Connie Hiers, MD, FACS · Answer

Your implants are too large for your frame and are sagging from the weight. i would suggest going smaller and placing them behind the muscle to give better upper breast fullness. the lower pocket can also be tightened.

Vivek Sivarajan, MBChB · Answer

Hi Kirsty,Thank you for your question and i'm sorry to hear you aren't happy. Judging from your photographs the result looks acceptable, but its difficult to tell when the arms are up. When you put your arms down it might be that the implant is starting to bottom out, this is where the weight of the implant causes the bottom of the breast to expand and the implant drop, whilst the nipple starts to ride high on the breast. The best way, in my experience, to prevent this is to do a pocket exchange when changing implants and go under the muscle, which is what you are asking about. I will often do this and particularly if increasing the volume as much as you have and when removing the previous capsule.
I hope this helps

Jason Pozner, MD · Answer

You are bottomed out - ie fold malposition. I would convert to a submuscular pocket and use galaflex mesh for support. You dont need a lift and if the implants are newer and you are happy with the size the existing implants can  be used

Gokhan Temiz, MD - Account Suspended · Answer

Hello and thanks for your question. According to your pictures and the information, the procedure can be performed the way that you want. Your implants can be placed under the muscle to the new pocket.

Can you advise on under muscle revision with new pocket? (Photos)

Answers (8)

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