Wanting my implants redone - what type of implant, positioning, etc. would be best for me? (Photos)

Dear Straightforward778884,




Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

This is a complex challenging case due to the periareolar scarring around a widened flattened areola, potential capsular contracture, over-released pectoralis muscle, thin tissues/skin and minimal fat. You truly need to see a breast revision expert American Board of Plastic Surgery certified plastic surgeon. Your revisionary surgeon will likely include extensive breast pocket work (if not complete capsulectomies if there is capsular contracture), placement of new implants, use of internal support (i.e. Galaflex), and another breast lift.

Dear Straightforward
You currently show implant malposition with bottoming out and lateral displacement. This is very common in patients who have strong pectoral muscles from bodybuilding, especially when implants are placed under the muscle. Each time you flex, the pec muscle pushes the implant downward and outward, which creates the wide cleavage gap and makes the implants sit too far toward your armpits.

Key Considerations in Your Case:
IMPLANT PLACEMENT
Because you are a competitive bodybuilder, over-the-muscle (subglandular) placement is usually the better choice to avoid “animation deformity” (the implant visibly moving with pec contraction).
This will also allow more control of implant position—closer together, with less risk of being displaced outward by the muscle.

IMPLANT TYPE
Given your thin tissues and skin stretch, silicone gel implants are strongly recommended over saline. Silicone will ripple less and feel more natural under thin coverage.
A slightly smaller implant than your current one may help reduce bottoming-out risk and improve upper pole balance.

ADDITIONAL TECHNIQUES
1. Capsulorrhaphy/internal bra: tightening and reinforcing the implant pocket with sutures or mesh to bring the implants inward (narrow cleavage) and upward (correct bottoming out).
2. Mastopexy (breast lift): may be needed depending on how much stretched skin and areolar widening you want corrected.
3. Areolar support suturing: a “locking purse-string” suture can help prevent further spreading of your areolae.
OTHER OPTIONS
Use of acellular dermal matrix (ADM) or synthetic mesh (“internal bra”) can provide long-term support for your thin tissues.
Some surgeons may also recommend a hybrid augmentation—using a smaller silicone implant with a bit of fat transfer (if any fat is available) around the implant edges to soften transitions and reduce rippling.

Final results and plan, however, absolutely depend on an in-person exam to assess your skin elasticity, breast tissue thickness, and implant pocket characteristics.

Warmly,
Earl Stephenson, Jr, MD, DDS, MBA
ESJ Aesthetics — “Where Confidence Takes Shape!”

I recommend explantation and lift using The Bellesoma Method. The implants are removed, your breast tissue is reshaped creating upper pole fullness, elevated higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained if not injured during your previous surgery. Later, fat transfers or small implants can be placed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Without hesitation, do opt for the subfascial pocke plane location for the new implants; you have a bad degree of animation deformity but... attention... this is not due to your strong muscles, it is caused by a poor release of the pectoralis muscle and a totally submuscular placement (a technique proscribed that should never be used, precisely because if this bad animation and other issues).

Secondly, you'd rather get modern cohesive gel filled anatomical shaped implants.

Finally, reduce those areolas and make pocket adjustments.

What you’re experiencing is called bottoming out with lateral displacement—very common in athletic women with strong pectoral muscles, especially when implants are placed under the muscle. The wide gap and implants sitting toward the armpits are classic findings.
Surgical options that help most: 1. Pocket revision with capsulorrhaphy (internal sutures): This tightens and redefines the implant pocket so the implants sit higher and closer together. 2. Conversion to dual-plane or subfascial (above the muscle, below the fascia): For women with heavy pec activity, moving implants out from under the muscle prevents the constant pulling laterally. 3. Switching from saline to cohesive silicone gel implants: These feel softer and hold shape better long-term, especially after pocket repair. 4. Implant shape/size: Choosing a moderate-profile implant or wider base can help reduce cleavage gap, though some natural gap will always remain due to anatomy. 5. Mesh or ADM (acellular dermal matrix): In revision cases with weak tissue support, surgeons may add reinforcement to keep the implants stable and prevent repeat bottoming out.
Expectations: With the right combination of pocket repair + implant change, most patients achieve a much more centered, lifted look with a softer, more natural cleavage line. Your strong pecs will always influence positioning somewhat, but surgery can make a big improvement in both appearance and comfort (like shaving under the arm).
I’d recommend consulting with a plastic surgeon who regularly does implant revision cases—this experience makes a difference in choosing the right approach for you.
Dr. M. Mustafa Aydınol, Plastic Surgeon (Istanbul)

Based on your photos and description of your goals there are a few options. Switching to a gel implant either moderate, high, or teardrop profile will give a more natural look. A breast lift is recommended to reduce excess skin as well as downsize the areola. You can consider placing the implant under the muscle even as a body builder. Visit with a board certified plastic surgeon near you to learn more.

Your case is complex and requires pocket revision and fat grafting to help the soft tissue coverage.

First and foremost, to make a quality assessment regarding the outcome of any plastic surgery procedure. We need to see quality before and after pictures.
If you don’t have before, and after pictures, then ask your surgeon to forward the pictures they took.
Consider reposting with your before and after pictures.
Breast augmentation outcomes are generally based on three variables.
when results are less than desirable, we can almost always trace the problem back to these variables.
The first is the patient candidacy for the procedure in the first place.
Not everybody is an ideal candidate for breast augmentation surgery.
Variables that alter candidacy include breast shape, breast position on the chest wall, breast size, and the angle of breast divergence.
If the breast sit wide on the chest wall, then this appearance can be amplified with the projection of the implants.
Likewise, if someone has a lot of divergence with the nipples pointing outward then this can look more obvious with implants.
The second variable is implant selection in regards to size shape, and type.
Each plastic surgeon will have their own way of guiding patients through the implant selection process.
As a general statement using excessively large implants will increase the chance of undesirable side effects, complications and need for revision surgery. The bigger than implant the more likely the patient is to have problems from the procedure and need further surgery.
The third variable is the surgeon ability to do the procedure correctly. In other words to put the implant in the correct anatomic location.
In your case, all three variables may be contributing to your outcome.
If you have faith in your provider, then follow up with him or her and talk to them about your outcome and revision surgery.
Otherwise schedule a few in person second opinion consultations with other plastic surgeons in your community.
Recognize that certain things cannot be changed with surgery.
This includes the ability to move the anatomic position of the chest on the chest wall.
If the breast sits wide apart, then that’s where they sit.
A revision and procedure may give some improvements, but it may also be challenging to get the type of results. You might have been hoping for.
Best,
Mats Hagstrom MD