Wanting opinions of my result from BA in September 2015, If you feel there is complication, what would be options to fix?(photo)
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Doctor Answers 5
My advice is without the benefit of physical exam or seeing your preoperative pictures, but it looks like you have developed symmastia. You do not mention whether your implants are above or below the muscle. If they are above the muscle, it is an easy maneuver to make a new pocket underneath the muscle and leave the central attachments of that pectoralis major intact to keep the implants apart.
If they are already under the muscle, then this would normally be treated by making a new pocket above the muscle and going with smaller implants to discourage this repeat. Also, wearing a “thong bra” for at least two or three months postoperatively would help.
I hope this has been helpful.
Robert D. Wilcox, MD
Options for Previous Breast Augmentation
While it would take an in-person exam to make a truly accurate diagnosis. It's hard to tell from the photos but you may have some degree of symmastia as well as some issues with the inferior fold. Repair can be achieved using a "scaffolding" product (Seri, Strattice, Alloderm, etc) that would help both with the cleavage and inferior fold issue. At the same time the visibility of the old inferior fold and inferior edge of the pectoralis could be addressed.
I agree that most of the aesthetic issues with your result are because of the size of the implants. Without going smaller it will be difficult to change this result. Good luck, Jane
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I would not say you have a complication as much as an unsatisfactory aesthetic result
It is impossible to provide a complete answer to your question here without benefit of a thorough evaluation including a review of preoperative images and a physical exam, but there are a few general comments I can offer. First, I agree with you, and I disagree with your surgeon. You do not have a very good aesthetic result, and I don't know many ladies who would want their breasts to look like this, or "love this result," unfortunately. I completely understand your concern, and I think you should trust your instincts; you are NOT being picky at all. I hate it so much when I hear that surgeons tell their patients that they are "picky!" It's your body after all, and if you aren't going to do everything you can to have the best outcome and you are willing to accept mediocre results, why do it at all? I know that some expectations are unrealistic, but this does not appear to be one of those situations. We all sort of know intuitively what a beautiful breast looks like, and even if we can't understand the details of what we're looking at, we still know if we're not looking at a beautiful breast. I can see several issues with your breasts just looking at the images. First, your implants are too large. I know that this might have been the size you really wanted, but the truth of the matter is that your natural breast tissue and your chest dimensions can't support this size and diameter of implant. It doesn't look natural or aesthetic. You can see the contour of the old inframammary fold and lower curve of your natural breast as it crosses the implant, and this is a very unnatural look. Second, your implants are not positioned properly. They are way too far toward the center of the chest, such that they are essentially touching and creating what we call "symmastia," or some ladies refer to this as "uni-boob." This is when the breasts cross the midline and touch so that you don't have a well defined cleavage. The other thing that this causes is the nipples to be pushed way too far laterally, or outward, such that they are off-center on the breasts. Third, you appear to have had some laxity, or ptosis of the natural breast tissue, and perhaps some component of constriction of the lower breast, or even tuberous breast as well. It's difficult to say exactly what it is without preop images, but the natural breast tissue, especially in the center surrounding the areola, still appears loose, and it appears to be just "sitting on top of" the breast implant instead of wrapping around it snuggly or conforming to it. Lasltly, your nipples are more or less angled downward instead of straight ahead or slightly upward, and this is an aesthetic issue as well.
The challenge now is what can or should be done about this? Again, it is next to impossible to provide a specific answer here without an exam, but a few things I can mention that should at least be considered are: 1) replacement of your implants with smaller implants, or at least ones with higher profile, such that they have more projection and less width, 2) repair of your capsules in the inner part of the breasts with repositioning of the implants outward and maybe slightly downward, this may also involve some modification of the capsule on the outside of the breasts as well, 3) consider a periareolar mastopexy, or lift, to decrease the areola diameter, raise the nipple and areola a bit, and maybe more importantly, to alleviate the laxity of the natural breast tissue in the central breast so that it is tighter and conforms more to the implants, this will go a long way toward eliminating the double contour on the lower breast, 4) consider relaxing the old breast tissue fold by cutting it internally if necessary to help alleviate the "double bubble," or double contour across the lower pole of the breast caused by the persistent fold and the implant, and lastly, 5) consider some fat graft of the lower breast to help camouflage the double contour, as part of it is created by a disparity between the natural breast tissue thickness and the thinner tissue covering the lower implant which had to be positioned there to create the proper dimensions of the breast - this is not an uncommon occurence, especially when using large implants in ladies with tight or constricted breasts with high natural inframammary folds. These are my initial thoughts after just reviewing your images and hearing your story. There very well may be more that can be considered once you undergo an exam, and this is admittedly a very quick list of some possibly confusing and complex concepts, but at least this gives you an idea of why I believe that you do have a less than desireable aesthetic result, and there is possibly much that can be done to improve things for you.
Having said this, I must say that these are not easy cases. I do a lot of revisionary breast surgery, and it is challenging, but if you find a board certified plastic surgeon with lots of experience in the latest techniques of breast surgery, and especially revisionary breast surgery, your chances for a much better outcome are very good. It would appear as though your original surgeon may not be up for the task, simply based upon your report that he thinks you are "picky," and that most ladies would be happy with this result. The outcome here may have much to do with your anatomy, but that's like saying "I can only get good results on patients with perfect anatomy, and if there is some difference in the anatomy that I don't recognize or can't deal with, it's all your fault." That to me is not the spirit of plastic surgery. I'm not saying that we can fix everything, or that there aren't some people with such challenging anatomy that we don't have a good solution, but this just doesn't seem to be one of those instances. If you discuss this openly and honestly with your surgeon, and you get the feeling that he is not receptive to re-thinking this situation and correcting the things that can obviously be corrected, I think it is fair to seek out another opinion, or multiple opinions, from other qualified surgeons who can help you. I wouldn't go so far as to say that this is a "complication," or that there was "malpractice" at all; it simply is an inferior aesthetic result, that's it. Every surgeon encounters this kind of thing from time to time. The important thing is not necessarily that a surgeon never has something like this happen; the important thing is how they deal with it when they do.
If you do decide to consult with other surgeons, in addition to being certified by the American Board of Plastic Surgery, your surgeon should also voluntarily participate in the Maintenance of Certification program administered by that board. This is the best way to know that your surgeon not only has the best training and experience for the procedure, but that he or she has maintained currency in the certification requirements as opposed to practicing on a "lifetime" certificate which has only been reviewed once at the beginning of his or her career. For more information on this you can visit ABplsurg.org, ABMS.org, and certificationmatters.org . Good luck.
Wanting opinions of my result from BA in September 2015, If you feel there is complication, what would be options to fix?
Thanks for your question and pictures. Without knowing your preoperative appearance and the details of your surgery, there are a couple of observations that I can make based on your photos. It appears that you have some visibility of your old inframammary fold. Since it has not stretched out after a year, you may benefit from fat transfer to the region to help soften the appearance of the constricted fold. The other observation is that it appears you have implants very close to each other (symmastia). If this bothers you, a revision may be possible. Symmastia is difficult to correct and you may need to downsize your implants. If these issues do concern you, I recommend further discussion with your plastic surgeon or consider meeting with another plastic surgeon for an in person consultation.