Advice on revisions/corrective action.Is "tacking" normal?Are these mistakes that can be fixed? Was my surgeon at fault?

Question

BA in May 2015...5'2, 108 lbs (1 child, lost 79 lbs) 300 silicone placed under muscle thru armpits! huge space btwn breasts, no cleavage & right side has double bubble & indent at the top that can be felt. Left side still not fully dropped so it sits a little high, also falls under arm when lying down. When flexed left side looks awful. Dr suggested an in office "tacking" procedure to fix but Im not comfortable w/that approach! Both breasts hang when bent over, as well (snoopy affect). Help!

Thomas A. Mustoe, MD, FACS · Answer

You do indeed have a double bubble with a dropped implant on the right, and asymmetry.  The transaxillary approach has an advantage in terms of the scar, but  it  makes it more difficult to get precise pocket creation and muscle release, and in general revisions need to be done either through an inframmary fold approach or a periareolar approach. The revision does involve tacking sutures,  but is considerably more complex than the original operation. I would get a better idea of what your surgeon proposes, and if you have concerns, get another opinion from someone experienced in revisional breast surgery.

Martin Jugenburg, MD · Answer

There is a double bubble on your right breast. You will require a revision to fix this. Speak with your surgeonRegards,

Nelson Castillo, MD · Answer

Thank you for your question and series of photographs.  I can see your area of concern and do agree that at nearly a year after initial placement that you will need corrective revision surgery to improve the appearance of your breasts.  Before surgery pictures would be useful in order to assess your starting point and hazard an opinion as to the distance between your breasts, nipple position, and need for a lift at the time of implant placement.  I agree that you have a double bubble deformity with your implant having settled too low on your chest as well as implant malposition issues with each breast.  See a board certified plastic surgeon for an in-person evaluation to discuss your treatment options.  These issues can be improved upon with surgical corrections.  Best wishes.

Robert S. Houser, DO · Answer

It's tough to tell without an in-person exam but here are some thoughts.  First, it's always tough to augment a breast in someone who has lost a lot of weight.  The breast slides off your chest a bit and so it is in a different location related to the muscle beneath it, making it a real challenge.  Also, you might have needed a lift but that's really hard to tell now.  Most surgeons would have employed a "dual plane" technique for addressing your initial concerns.  Personally, I don't like the trans-axillary incision and I'm not certain how well a dual-plane approach can be carried out through that.  As for cleavage, you have wide set breasts so a lot of cleavage may not be possible with a submuscular implant.  Can it be fixed?  Sure.  The implants need to be placed in a little different plane.  The bottom of the capsule needs sutured closed.  You might want to consider a higher profile implant.  That is all likely going to require a different incision too -- another reason I don't like going through the armpit.  Discuss it with your surgeon and also get a few other in-person opinions.  Good luck!

Darryl J. Blinski, MD · Answer

Recommend  open infra revision to close lateral pocket and open medal pockets. Transaxillary incision option has this lateral poor dissected medial pocket issues.

Gaurav Bharti, MD, FACS · Answer

It appears that you would benefit from revision breast augmentation to correct the animation deformity and the implant malposition. Multiple options exist to improve your result. I would have further discussions with your surgeon to make sure you and him or her are comfortable.

Advice on revisions/corrective action.Is "tacking" normal?Are these mistakes that can be fixed? Was my surgeon at fault?

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