In '94 had saline implants under the muscle. If I change to cohesive gel, will that help round them out? (Photo)

I want to be able NOT to wear a bra, as I live in a warm humid climate...that is my goal, and have the tee shirt look smooth, not with a line in the middle. Is this possible? I am a very young active 71 year old woman who still likes to look nice. Three years ago I had a scar revision that did little to help them look less like a cut McDonalds hamburger.

Doctor Answers 7

Switching Implants?

Thank you for your question!  I would seek a board certified plastic surgeon who performs them routinely.  Best of luck!


Dr Dhaval Patel
Double Board Certified
Plastic Surgeon
Chicago
Hoffman Estates
Oak Brook


Hoffman Estates Plastic Surgeon
4.8 out of 5 stars 79 reviews

Revision

Sorry that you are unhappy with the reconstruction. I tend to disagree with the other opinions posted here. In breast reconstruction after mastectomy, the breast shape is determined to a large extent by how your skin stretches out with tissue expanders. I don't think any implant will give you a better result. You need a revision that includes the following:
1. Remove the implants, raise the fold (your folds are too low), release internal scar tissue and replace with tissue expanders
2. Expand till a good shape is obtained
3. Place an appropriate implant. 

This is a long process but the only one that will give you good results.

Matthias Solomon, MD
Dallas Plastic Surgeon
5.0 out of 5 stars 9 reviews

Breast reconstruction revision

It appears that you have had some contracture of the scar around your implants, and I believe this is contributing to the line or depression in the middle of your breasts.  A capsulotomy or capsulectomy along with replacement of your saline implants with  a form stable silicone implant such as Allergan style 410 should help.  A further lower pole elliptical skin resection could also be considered.  A nipple reconstruction will also aid in breaking up this line, but this may need to be performed as a secondary surgery.  Best wishes, Dr. Lepore.

Vincent D. Lepore, MD
San Jose Plastic Surgeon
4.9 out of 5 stars 50 reviews

Revision breast reconstruction

Thank you for your question and post.

Congratulations on your surgeries and recovery to this point. You have a great result. The line in the middle of the T-shirt is a result of your mastectomy scars. Nipple reconstruction will give you a more natural looking "through the T-shirt" look because a nipple will be visible. This can be performed in the office or under quick anesthesia.

A scar revision will take care of the thick mastectomy scar. 

As for the shape of the breasts. You already have a good result, and at 71, I would really avoid big procedures to alter the shape. Fat grafting may give you a rounder look.

I hope this helps.

- Dr. Bryson Richards

Getting roundness is difficult

Thanks for your question and the photo. I can appreciate your frustration and realize it is not unique to you. Because of the orientation of the mastectomy scar and its length, this effaces the front of the breast. I have been using the Mentor HP shaped medium height. If the lower pole is tight, it might be helpful to place Alloderm inferiorly. There is no magic wand however for this unfortunately. Best of Luck!

M. Scott Haydon, MD
Austin Plastic Surgeon
4.9 out of 5 stars 84 reviews

Breast reconstruction

Thank you for your question and photo.  A highly cohesive gel implant will typically give you a much nicer shape and feel than your saline implants used for reconstruction.  Saline implants are essentially never used for breast reconstruction in this day and age because of the vast improvement with silicone gel technology.  Definitely visit your reconstructive plastic surgeon who can go over options with you. 

Brian C. Reuben, MD
Salt Lake City Plastic Surgeon
5.0 out of 5 stars 31 reviews

In '94 had saline implants under the muscle. If I change to cohesive gel, will that help round them out?

Based on your photo- it appears that there is a disparity between the position of your implants and the lower skin. This transverse scar could be used to excise the lower skin - therefore tightening the bottom portion. At the same time- I would release the implant so that it fell downward slightly- and replace theses implants with the 410 Natrelle gel implants- which is a shaped implant filled with cohesive gel. That will give you in my opinion a more natural looking breasts. 

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