What are my options to revision? (Photos)

I have over the muscle smooth round moderate profile saline (R 300cc/L 275cc) from 2011. I am frantically looking for a doctor to revise my breast for a fuller and stable appearance. It is almost impossible to lay down on my back because my breast slide to the sides. They are floppy, rippled, and saggy looking. I would appreciate any advice and photos links to revisions!

Doctor Answers 7

What are my options to revision?

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I am sorry to hear about the problem you are experiencing.  And maybe in your best interest to undergo revisionary breast surgery involving conversion of the sub glandular breast implants in to the sub muscular (dual plane) position).  

Sometimes, patients undergoing conversion of breast implant positioning from the sub glandular to the sub muscular space benefit from additional maneuvers such as breast lifting (depending on the position of the breast skin envelope in relation to the position of the sub muscular breast implants) and/or the use of acellular dermal matrix for lower pole support and/or additional coverage of breast implants. Closing off the existing breast implant pocket is a technique utilized to help prevent the breast implant from moving back into its previous space.  Alternatively, the lateral breast implant displacement can be corrected using an internal suture technique, decreasing the size of the pockets and moving the implants toward the midline. In my practice, I use a 2 layered suture technique to close off the space laterally (towards the axilla). The use of acellular dermal matrix is an option ( although not usually necessary) especially if significant implant rippling/palpability is present.
Successful results do depend, to some degree, on the surgeon's experience. Therefore, best to make sure that your plastic surgeon can demonstrate significant experience helping patients with this type of revisionary breast surgery.

I hope this, and the attached link, (dedicated to revisionary breast surgery concerns) helps. Best wishes.

Breast Lift May be Beneficial with Revision

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A breast lift with or without implant #replacement may actually be beneficial. In fact, the most common #breastprocedures include #mastopexy or #breastlift, #breastaugmentation, or #breastreduction. A #mastopexy or breast lift operation is designed to improve the shape and position of the breasts without reducing their size. It is the most suitable for #breasts which sag or droop (ptosis) as a result of development, aging, pregnancy, breast-feeding and weight loss . Some patients will experience better results to restore superior fullness if an #implant is used at the time of mastopexy; better known as #AugmentationMastopexy. Or, a lift can be accomplished while the current implants remain if satisfied with size and volume. If deciding on new implants, their  placement may be changed from their current location. The best technique and surgical approach will be discussed in greater detail during your one-on-one, in-person consultation.

Altogether, the surgery will create an elevated, more youthful breast contour. Also, the nipple and areolae of the desired size and correct height may also be addressed. I prefer to use a #shortscar technique, #LollipopScar or #DonutLift” rather than the majority of surgeons in the United States that use an anchor pattern lift which involve more significant scarring.The best method and #technique for your #procedures will be discussed in greater length during your one-on-one consultation with a board-certified plastic surgeon.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 116 reviews

What are my options to revision?

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Thank you for your inquiry.  Sorry to hear about your situation.  

After viewing your photos, I feel a number of things can be changed in a revision surgery to improve your situation.

First,  I would recommend a re-augmentation to convert you from a subglandular plane to a submuscular plane.  

Second,   I would recommend silicone implants over saline for someone as thin as you are.   Silicone implants in a submuscular plane for you would significantly improve your rippling issue.  Also I would recommend using a higher profile implant which is more narrow and has better projection than your current implant.

Third,  I would recommend using a dermal matrix to help stabilize the new placement of the implant, control the lateral pockets so your implants don't slide to the side and give you support in the lower portion of your breast.

Fourth, you may also benefit from a lift but it is difficult to say with any confidence without examining you.

Implant and pocket revision

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It appear that you may need a pocket revision and possibly a lift. Hard to say for sure without the exam.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

What are my options to revision?

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Based on the pictures, a revision with work on the breast implant pocket and a breast lift may be the best option. See link below for examples. 

Karol A. Gutowski, MD, FACS
Chicago Plastic Surgeon
4.9 out of 5 stars 76 reviews

What are my options to revision? (Photos)

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There are several issues which need to be addressed in your case. I would recommend the following:

- Pocket conversion to submuscular implants

- Conversion to highly cohesive silicone implants

- Mastopexy or breast lift to lift the breasts, particularly the right breast and improve symmetry

Do your homework. Pick a good board certified plastic surgeon who does lots of revisions. These cases are obviously more complex than primary breast cases.

I've attached a link for your information. Best of luck.


What are my options at revision?

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Thank you for sharing your photographs and questions.  I would recommend a several prong approach to improvement in your current breast appearance.  I would first recommend switching from saline to silicone implants and placing them underneath your pectoralis muscle. This position leads to natural results, increased soft tissue coverage of the implant and trends towards few complications.  Based on your tissue quality you may benefit from placement of an internal bra to help support the weight of your implants and remove it from your breast skin, hopefully preventing recurrence of implant malposition.  You will also likely require a breast lift to help remove excess skin and to help reposition your nipple into a more youthful position but this is best assessed during an in-person examination.  

Nelson Castillo, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 80 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.