1 year post op, what can be causing dents between breast implants? Mentor memory gel 275cc (photos)

Question

I had breast augmentation a year ago Mentor MemoryGel 275cc and I have dents between breasts on the lower areas without flexion. What is causing this?

Jeffrey M. Darrow, MD · Answer

Your dents come from where the pectoralis muscle was released during surgery. What you’re seeing is the very bottom portion of the release. Below that there is no pectoral muscle but there’s only breast tissue which is thin and causes a dent.  A certain percentage of people do get this, according to what they’re anatomy was prior to the surgery and what manipulation of the pectoral muscle was done.

Semih Yildiz, MD, FEPOBRAS · Answer

From the photos, the dents look like medial/lower-pole contour irregularities rather than something that can be diagnosed with certainty online. Common causes after augmentation include thin soft-tissue coverage over the implant, implant edge visibility or folding/rippling, scar capsule or pocket tethering, and sometimes implant position or pocket dissection along the inner lower breast. Even without flexing, the pectoralis muscle, implant pocket, and capsule can all influence how that area looks.

At one year, this is best assessed in person by your surgeon, especially if the dents are new, worsening, painful, associated with hardening, or changing your breast shape. Treatment depends on the cause: observation if stable and mild, fat grafting for thin coverage/rippling, or capsule/pocket revision such as capsulorrhaphy or internal support if there is tethering or malposition. An exam can determine whether the issue is implant visibility, capsule contracture, pocket anatomy, or soft-tissue thinning.

Onur Ogan, MD · Answer

Hello smcst8
Breast implants may be visible at the edges if there is insufficient soft tissue that is covering them. This situation is more common if the implant is placed over the muscle since the only soft tissue that is covering the implant is breast tissue and skin. Sometimes capsule of implants may be pulling the skin with movement causing more obvious dents which is called rippling. Best way to get rid of them is having fat transfer to fill the volume loss at the edges of the implant. But if it is a serious rippling capsule removal with changing implants and having fat transfer should be considered. 
I hope this information would be helpful

Brian K. Reedy, MD · Answer

Thanks for your question! It could be the way the muscle is covering the implant. It could also be rippling. Lastly, it could be your natural anatomy. I would encourage an in-person follow-up appointment with your surgeon to evaluate and consider recommendations. Good luck!

Martin Jugenburg, MD · Answer

Hello, thank you for your question. Rippling can happen with any implant, implants without rippling would be a hard round ball and of course this is undesirable. It more pronounce in patients who have thinner skin and not a lot of natural breast tissue/body fat. Nothing really can be done about the rippling except consideration of fat grafting to the area to help minimize the appearance. Speak to your plastic surgeon if you are really bother by this.

Daniel Barrett, MD · Answer

Dear smcst8,
I understand your concern. However, without a proper assessment, it would be difficult to determine what went 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, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Camille Cash, MD · Answer

Based on the location of the breast contours that concern you, it is likely to be caused from one of two reasons.  One is the rippling of the implants.  This is less common with gel implants than saline implants, but can occur with either.  The second would be where the muscle is coming across the implant.  This is often disguised with natural breast tissue, but for some who have little breast tissue or thin skin it can be visible.

Connie Hiers, MD, FACS · Answer

From the location and shape of the dents, I suspect it is related to your bra, especially ones with underwire.

Victoria Aimé, MD · Answer

Dear smcst8,There are a few things that can cause the appearance of irregularities along the lower inner aspect of the breast following breast augmentation with implants. 
1. If the implants are placed under the pectoralis muscle, the lower inner margin of the muscle is usually released to allow the implant to settle into the lower breast pole. If the muscle is not released quite enough along the inner aspect, the lowest remaining fibers can act as a tether and push the implant outward. Usually, this makes the implant/breast look more flat rather than rounded, but it can cause contour irregularities that would look like a dent or tether in the overlying skin. 2. In thin patients, rippling of the implant can be seen through the skin because there is simply less breast tissue and fat tissue to cover the implant. Implants that are less filled are more prone to this.3. If an implant is insufficiently supported by the breast tissue, it can begin to bottom out with time. The weight of the implant (usually seen with larger implants) or poor tissue tone (usually due to genetics and aging) can cause the lower breast tissue and skin to stretch and allow the implant to slide downward. This is more common with implants placed above the muscle because there is less tissue to support the implant in the lower breast pole. 4. A combination of these things
In your case, it looks like the implant may be bottoming out somewhat and may benefit from being repositioned (a capsulorrhaphy) possibly with mesh placement for additional support. I recommend following up with your surgeon for an in-person exam so they can help guide you on what, if anything, should be done. 
 All the best,Dr. Victoria Aimé

1 year post op, what can be causing dents between breast implants? Mentor memory gel 275cc (photos)

Answers (9)

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