Should I Have my Implants Placed Under the Muscle and Get a Lift?

I'm 21 5'6" 115 pounds mother of 2. I had 450 cc high profile saline implants placed above the muscle. The size is exactly what I wanted. I opted not to get a lift & now feel my areola & nipple are far to low. The size of my areola does not bother me. I was told I could achieve lift & a natural appearance with overs & the size but I feel that they look VERY unnatural & my bra straps do not lay flat against my upper chest. Will they change any more? Should I have a lift & get them placed under?

Doctor Answers 19

What can I possibly say other than this is crazy?????

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I have to say in all honesty that I am absolutely shocked by the result you have.   Can it possibly be that you went to a real Board Certified Plastic Surgeon or was it one of those pretenders who does breast surgery without formal training (ie. a "cosmetic surgeon")?

There are so many things wrong here:

1. You absolutely needed a full lift from the start.  Nothing short of that would look any good from your starting point.  Your breasts were too droopy to get by with anything but a full lift.

2. Saline implants do not belong above the muscle in a thin person as they will either be dramatically overfilled and hard and edgy or else they will be filled appropriately but will be very wrinkly.

3. Implants above the muscle do NOT LIFT THE BREAST - please would everybody stop deluding themselves into thinking that!!!!

4. You couldn't look much more unnatural than you do. The implants are a poor choice for your frame.

You still have tapes on the skin so I presume your surgery was recent.  This will not improve with time.  If your implants settle they will look like huge balls in a sock, very very matronly for a 21 year old. Personally, I would have them out now, heal for 6 months or until you are 22, go to another surgeon and start over with gel implants below the muscle and a full lift.  Sorry you are going through this.  Even if you pushed for any of this yourself, a responsible experienced surgeon would have saved you from these mistakes and guided you down a better path.  This was ridiculous.

This is unacceptable! Poor Surgical Judgment

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I have reread your question a few times now and my answer is going to be a bit tough. As my colleague's have mentioned YOU stated that you didn't want the lift scar. OK fine, but a surgeon who possesses a  decent skill set should have told you the truth. The truth being that you either get a lift or get very unhappy. Those of us that have been ethically influenced would have put on the brakes and had a serious sit down and discussed WHY you need that lift. Now you have money invested, discomfort from the operation and certainly in need of additional surgery. I would immediately remove this set of implants. I would wait a minimum of 6 months. I would then seek out a DIFFERENT SURGEON.  You need a lift , and keeping this size implant makes the lift very difficult. You can appear this full with a much smaller implant when the lift has been performed simultaneously. If this is not the appropriate time in your life then wait until you are ready. Do not in any way take this as an acceptable result. This surgeon lacks judgment and we all out here in our communities feel saddened by outcomes like this.  The good news is it can be fixed. 

Charles Virden, MD
Reno Plastic Surgeon
5.0 out of 5 stars 70 reviews

You need a revision!

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Dear Jenn, I am sorry you had such a poor result but I really don't feel that all is lost.  Let's start with the first problem.  You are tall and thin. you don't have a lot of breast tissue and your creases are fairly high.  I think that high profile saline implants do very poorly in a patient like you.  Moderate profile plus or style 15 implants (gel) do much better in these cases and almost always need to be under the muscle.  The problem comes in because you are under 22, the legal limit according to the FDA for silicone.  So I would not do a revision until you can have silicone implants.

As far as the lift, no plastic surgeon wants an unhappy patient, but you were doomed to be one when you opted not to have a lift.  By putting the implants over the muscle you also gave a very artificial appearance to an already doomed result.  I also think this is complicated by too small a pocket and possibly even a capsular contracture.

Finally, using an incision underneath the breast in what looks like below the crease has caused more exaggeration of the ptosis instead of improvement.  Going periareolar would have been a better choice as this could be incorporated into a periareolar or lollipop scar from a mastopexy.

So what I would recommend just by looking at your photos and not seeing you in consultation is the following: Waiting until you are 22 to get silicone, going under the muscle, doing some type of lift to reposition the areola at the apex of the breast and though you may not like to hear this, going with a smaller less projecting implant.  Give yourself at least 3 months for all to settle down and then speak to your plastic surgeon.  Good luck, Dr. Schuster from Boca Raton

Revisionary Breast Augmentation/Mastopexy Surgery?

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Thank you for the question and pictures.

Yes, you will benefit from revisionary surgery. This operation will involve mastopexy and reaugmentation ( preferably in the sub muscular or dual plane position).

Given your negative experience thus far,  I hope you will take your time and do your due diligence given that the revision surgery is relatively complex. Make sure your selected surgeon has significant experience that he/she can demonstrate to you.

Best wishes.

Need a lift? Replace breast implants?

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What your surgeon chose to do in your case makes no sense whatsoever.  Where to begin. It is obvious from your photos that you needed a lift, and that would be a full lift and not a minor lift with just scars around the areola.  Putting implants in the breast will fill it out but it will NOT LIFT THE BREAST! Putting really large implants in the breast will really fill it out BUT WILL NOT LIFT THE BREAST!  Saline implants can look less natural than silicone gel implants, in patients with thin tissue they can look even less natural, if placed above the muscle in a thin patient they can look even less natural, and if they are high profile saline implants placed over the muscle in a thin patient they will look about as unnatural as one can imagine...unless they are put into a patient who needs a lift but doesn't get one, in which case they will look beyond unnatural.  You need to have these implants removed, ideally silicone gel implants placed under the muscle, and a full lift...and it is possible that this should be done in two stages.  Make sure that you go to a sugeon who is certified by the American Board of Plastic Surgery...I would wonder whether the surgeon who chose your surgical plan is.  Good luck! You deserve a much better result, you can get a much better result, and it is unfortunate that you have to go through more surgery to obtain one, but ultimately things should work out.

Breast lift with implants

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The position of your implants is  not the main issue

You need a vertical breast lift .I would replace the saline implants with moderate plus silicone gel,my preference is subfascial.You may also consider slightly smaller implants

Hilton Becker, MD
Boca Raton Plastic Surgeon
4.6 out of 5 stars 15 reviews

Follow the advice of your doctor.

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I am sorry you are not happy with your breast augmentation.  From your photos I can understand why.  Even though it is sometimes hard to follow the advice of your surgeon, especially if he/she is telling you that you need  a lift, it is generally better to follow their advice.

You DO need revision surgery.  Time is not going to solve your problem.  The difficult thing is that it may be too risky to perform the implant repositioning and the lift at the same time.  You need to meet with several board certified plastic surgeons to get their opinions before proceeding.

Richard H. Fryer, MD
Salt Lake City Plastic Surgeon
4.9 out of 5 stars 297 reviews

Alll is not lost

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There were a number of poor decisions made by your surgeon as mentioned by my colleagues, but what are you to do now?  Start by seeing several board certified  plastic surgeons for examinations and advice).  Look for a surgeon who does a lot of breast lifting; not just augmentations.  It is a technical and demanding procedure and not the same as augmentations alone.  I would recommend moderate plus profile silicone gel implants placed under your chest muscle and  anchor shaped breast lifts.  The concern is that when your implants were placed over the chest muscle the blood vessels from the muscle to the back of the breast were cut.  This will forever compromise the amount of lifting of your breast tissues that can be done safely.  You are at a slightly higher risk of losing skin and breast tissue so whatever lift is done should be done carefully and by a surgeon who understands this issue (i.e. board certified plastic surgeon.  Moving the implants under the muscle will not change the diminished blood supply caused by the subglandular placement of your current implants.  It will improve the softness and shape of your upper breasts.  Fortunately, you are young and like larger breasts so for right now not a great deal of lifting is needed.  However, you are only 21 and large implants combined with time and possibly more children will cause your breasts to sag further.  You might want to re-think the size.  At least consider the consequences since you have another opportunity to improve your result and outlook.

Lori H. Saltz, MD
San Diego Plastic Surgeon
4.3 out of 5 stars 29 reviews

Should I Have my Implants Placed Under the Muscle and Get a Lift?

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The only change you should do is find another , at least boarded,PS to revise this unacceptable result. Sorry for your issues. Yes a full lift the sub muscular placement is in order. 

Should I have my implants placed under the muscle and get a lift?

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The preoperative evaluation of your breasts is extremely important.  Your photographs clearly show that your nipples are present at the lowest pole of the breast and the diagnosis for this appearance is called "severe ptosis".   Patients with severe ptosis need a breast lift procedure.  I would put new implants under the muscle with a lift.  You were very clear that you liked your size and that should be respected.  Being extremely thin, your implants will not have a natural appearance at this size so you need to make that decision carefully.

Elizabeth S. Harris, MD
San Antonio Plastic Surgeon

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