Nine months ago, I had a breast revision due to significant dropping of my breasts over the inframammary fold. Despite replacing 325cc silicone implants with 400cc gummy bear ones, both breasts remain boxy, dropped again, with flatness under the nipple and increased distance between them. I'm a 45yo female, 120#, fairly active. Unsure if my expectations are unrealistic or if this is my anatomy. Reluctant to undergo another revision. What causes this?
April 20, 2024
Answer: Revision after an augmentation mastopexy: boxy breasts A Class Act Dropped & Boxy Again can happen with a revision or the initial augmentation mastopexy Breast problems requiring revision BOTTOMING OUT This is the term given to implant displacement, where the implant drops down below the existing inframammary fold (natural crease beneath your breast). This may occur when the fold has been released excessively during surgery or may be due to factors of the patient’s collagen and tissue integrity. The implants end up sitting very low on the chest and there is lack of internal support for the implant itself. Correction usually involves restoring the crease beneath your breast to its normal position. This involves internal reconstruction including the capsule around your implant (capsulorrhaphy). Sometimes a biologic fabric (Acellular Dermal Matrix) can be used to attach to the breast tissue internally and support the implant. This corrects the placement of the implant, redefines the breast shape, and refines the internal fold. For you changing the profile of your implant and size along with a mesh may be helpful STRETCH DEFORMITY This occurs when the breast fold is in the correct position, however, the length of the tissue between the nipple and the fold stretches. This may be due to the patient’s soft tissue inelasticity and/or the size or shape of the implant that is used. Skin laxity can change with age, pregnancy, weight changes, or heredity. Correction of this problem usually includes skin excision as part of a mastopexy (breast lift/reshaping). It may be necessary to use ADM to further support the breast tissue if too thin. CAPSULAR CONTRACTURE This is a condition where the capsule around the implant thickens and squeezes the implant making it hard and often changing the shape and position of the implant. It is more common in nicotine users (e.g. smoking or nicotine patches or gum). Effective treatment of the capsule frequently involves completely removal of the capsule (capsulectomy), and occasional incisions in the capsule may be somewhat helpful (capsulotomy). In the past, closed capsulotomy, in which the breast is squeezed until the capsule breaks, was used. Currently, most doctors avoid this technique because of complications associated with the technique and because the implant companies will void their warranty if this technique is used. At times it is necessary to change the position of the implant, either above or below the muscle, depending upon the initial position, changing the implants themselves and, on occasion, the use of Acellular Dermal Matrix (ADM) may be required to prevent continued problems. Although the published risk of capsular contracture is approximately 9-11%, in our practice it is somewhat lower after initial implant placement. Once capsular contracture occurs, the risk of problems with secondary surgery rises to between 25% and 40%. The use of Singulair and Vitamin E may be of benefit. If you had a Sientra Textured Implant placed as a primary procedure and a contracture occurs in the first two years after primary augmentation, then their implant warranty may apply.
Helpful
April 20, 2024
Answer: Revision after an augmentation mastopexy: boxy breasts A Class Act Dropped & Boxy Again can happen with a revision or the initial augmentation mastopexy Breast problems requiring revision BOTTOMING OUT This is the term given to implant displacement, where the implant drops down below the existing inframammary fold (natural crease beneath your breast). This may occur when the fold has been released excessively during surgery or may be due to factors of the patient’s collagen and tissue integrity. The implants end up sitting very low on the chest and there is lack of internal support for the implant itself. Correction usually involves restoring the crease beneath your breast to its normal position. This involves internal reconstruction including the capsule around your implant (capsulorrhaphy). Sometimes a biologic fabric (Acellular Dermal Matrix) can be used to attach to the breast tissue internally and support the implant. This corrects the placement of the implant, redefines the breast shape, and refines the internal fold. For you changing the profile of your implant and size along with a mesh may be helpful STRETCH DEFORMITY This occurs when the breast fold is in the correct position, however, the length of the tissue between the nipple and the fold stretches. This may be due to the patient’s soft tissue inelasticity and/or the size or shape of the implant that is used. Skin laxity can change with age, pregnancy, weight changes, or heredity. Correction of this problem usually includes skin excision as part of a mastopexy (breast lift/reshaping). It may be necessary to use ADM to further support the breast tissue if too thin. CAPSULAR CONTRACTURE This is a condition where the capsule around the implant thickens and squeezes the implant making it hard and often changing the shape and position of the implant. It is more common in nicotine users (e.g. smoking or nicotine patches or gum). Effective treatment of the capsule frequently involves completely removal of the capsule (capsulectomy), and occasional incisions in the capsule may be somewhat helpful (capsulotomy). In the past, closed capsulotomy, in which the breast is squeezed until the capsule breaks, was used. Currently, most doctors avoid this technique because of complications associated with the technique and because the implant companies will void their warranty if this technique is used. At times it is necessary to change the position of the implant, either above or below the muscle, depending upon the initial position, changing the implants themselves and, on occasion, the use of Acellular Dermal Matrix (ADM) may be required to prevent continued problems. Although the published risk of capsular contracture is approximately 9-11%, in our practice it is somewhat lower after initial implant placement. Once capsular contracture occurs, the risk of problems with secondary surgery rises to between 25% and 40%. The use of Singulair and Vitamin E may be of benefit. If you had a Sientra Textured Implant placed as a primary procedure and a contracture occurs in the first two years after primary augmentation, then their implant warranty may apply.
Helpful
April 15, 2024
Answer: Revision From the photo it appears the implants may be too large for your frame. A revision to the lift as well as different implants may yield a better result. Adding mesh reinforcement would also add support. I've included a video on this that I hope you find helpful.
Helpful
April 15, 2024
Answer: Revision From the photo it appears the implants may be too large for your frame. A revision to the lift as well as different implants may yield a better result. Adding mesh reinforcement would also add support. I've included a video on this that I hope you find helpful.
Helpful