5 months post op. Are my implants too high is a revision needed? (Photo)

Question

I have anatomical textured high profile 310 implants at the end of last august. From the side to me they look odd as though they are too high, I have a bump for the upper pole and no lower with my nipples too low. I feel they look odd sticking out from my body. Is this how my result should be given how I looked before the op and my weight being overweight? or are the implants too high? or maybe a larger round implant would have produced a better result to create a fuller lower pole? Thankyou

David J. Levens, MD · Answer

As you note, your implants are located somewhat higher than ideal. An eye opening paper by Drs. Branford and Mallucci from England published in the last few years details the optimal aesthetics for the breast. Ideally, there should be a bit more breast volume below the nipple than above. This ratio often requires a careful lowering of the fold below the breast at surgery to place the implant more properly for balance.Your result is certainly not that unusual. There is a period of time postop (about 2 months) when the implants normally "settle" and may improve the upward positioning, but at 5 months, further change is unlikely.You should express your concerns to your surgeon and discuss options for revision.

Gary Lawton, MD, FACS · Answer

The lower pole of the breast is inadequately released.  This is not how you should look based on your preoperative photographs.  The inferior pole and muscle need to be released.  This is not a function of the implant but of the technique and skill used to create the pocket.

Joel Patrick Maier, MD · Answer

Indeed, it looks like you implants are
located high on the chest wall not filling out the lower pole of the breast. It
is very likely that you will need pocket revision, which is a discussion
between you and your surgeon. The implants look like the perfect size for your
build. Good luck and thanks for sharing.

Brian C. Reuben, MD · Answer

Thank you for your question and photos.  From your before photos, you have a very short distance from the nipple to the bottom of the breast.  In order for the implant to be centered under the breast, this distance needs to be elongated or you end up with a situation that you are in, where the implants are riding quite high.  In all likelihood, they will not drop.  To get them centered under the breast and nipple, a revision procedure will need to be performed.

Maisam Fazel, MA, MBBChir, FRCS · Answer

At present the implants do appear to be a little high. In most cases, implants have settled by 3 months but occasionally this can take a little longer. I would suggest waiting for another 6 months. If they haven't dropped by that stage I would consider a small revision to lower your implants. I would suggest discussing this with your surgeon to make a plan for this possibility.

Paul Banwell, BSc, FRCS(Plast) · Answer

hello therethank you for your questionsit appears as though the implants are still riding a little high. It usually takes 4 months or so for things to drop but you have gone just beyond this time. it is possible that further changes will occur but this is perhaps now unlikely.In actual fact your scars are lower than the current implant height suggesting that the implants have not dropped as much as your surgeon would have expected.I suggest you go back to discuss this and I am sure they will be able to reassure you and discuss pocket adjustment with revision. Also to answer your question, the shape of the implants would not affect the lower pole.Good luck!

Alejandro Nogueira, MD · Answer

Sorry for the critical opinion and the disagreement, to my opinion:-too high implants, the submammary fold was not suitably lowered and the nipple is not the center of the implants-submammary incision not properly planed and wrongly located-width of implants' base unadequate, should be wider to fill your cleavageI think that anatomical shape implants in a case like yours, hypoplastic and skinny, are the right choice, specially if cohesive gel like yours.You need full revision of the result, find a good surgeon expert in such cases. I must warn you that there is a big problem now: when the new wider implants will be properly centered behind the nipple, the new sumammary fold will be lowered as much as to make the current scar be located in the middle of the breast somewhere between the nipple and the new sumammary fold; this has no technical solution.

Camille Cash, MD · Answer

From your photos it does appear that your implants are still too high.  Typically implants will have dropped by this phase post op.  I encourage you to discuss your concerns with your surgeon.  It may be that surgical intervention will be necessary to get the implants seated correctly in the pocket.  The size looks very appropriate for your frame.

Gary L. Ross, MBChB, FRCS · Answer

Sorry to hear about your experience.I would agree with all the previous answers that all recommend revision. Unfortunately the incision has become visible due to the implants rising into an oversized pocket. It may be that your surgeon tried to stop migration lower and bottoming out by fixing the fold - but in doing so forced the implants higher. The simplest revision is to have the pockets reopened and to have a taller height implant placed with more projection in the lower pole. This may mean going a little larger although there are implants that are a similar size that could be used if you didn't want to increase in volume. It is possible to try and close off the upper pocket using the same implants and enforce the implants lower  towards the incisions with release of the lower pole - but there is always a tendency even in this scenario for the implants to rise up again.I suppose the big question is timing and I would discuss this with your PS. If you are in any doubt get a second opinion.

Stephen M. Davis, MD, FACS · Answer

One of the difficulties with textured implants is, they typically stay where they are placed. Based on your photos the implants appear to be too high and in all likelihood you will need a revision.Good LuckStephen M. Davis, MD, FACSGreen Hills Plastic Surgery

5 months post op. Are my implants too high is a revision needed? (Photo)

Answers (10)