Should I consider swapping my smooth implants with textured? (photos)

Question

I had a breast lift with 350cc smooth hp implants (dual plane) in Feb. From 2 weeks I noticed one of my breasts sat lower than the other and my nipple was pointing outwards, was higher and my scar was no longer in the crease. I had my 3 month review and it was confirmed I would more than likely need a review as the implant had dropped. I have my revision surgery booked but I'm concerned it will happen again and am unsure whether to change from smooth to textured.

Benjamin Baker, BMBS MBA FRCS(Plast) · Answer

Thanks for your question. You have a combination of asymmetry of implant position and of the skin envelope. Switching to a textured device will not eliminate the risk of the implant dropping again (known as bottoming out), but it would be worth considering this, or a polyurethane implant, to reduce the risk. You should be aware, though, that textured devices come with their own risks including a relatively recently discovered and very rare association with anaplastic large cell lymphoma (ALCL). You could also consider revising the lower pole tissue of your breast and insertion of a supportive mesh (known as an 'internal bra') to help with implant support. Consult a plastic surgeon with a specialist interest in aesthetic breast surgery.

Gary M. Horndeski, MD · Answer

In your frontal view, your breasts are wider than your chest wall. I recommend swapping your implants for smaller implants and I do not recommend textured implants as they are associated with BIA-ALCL.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Ronald J. Edelson, MD · Answer

The problem is that the distance from your nipple to the inframammary fold is too long causing the implants to bottom out.  That can be corrected without converting to textured  implants

Oliver Harley, FRCSEd(Plast) · Answer

thanks for your question;   implant mastopexy is an op that is commonly done, too commonly in my view, because it has some significant drawbacks - essentially you are asking a lot of biological breast tissues to accommodate an implant (350 is reasonably large) whilst at the same time removing skin that would otherwise be available to make space for the implant.  The breast and scar therefore stretch and the stretch process is not easy to predict and it may well be different one side for the other - so you end up with quite noticeable asymmetry....and almost without fail the lower curve/pole stretches and lengthens more than you might ideally want it to.  Smooth implants will add unpredictability to this process because they have more tendency to move or migrate.  A more sensible and predictable approach for most cases is to do either the implant or the uplift first (whichever you MOST want) and then when its all settled, do the uplift or the implant IF you still feel you want this.......on many occasions I do one and the patient says she is happy without progressing to second stage.  If both the implants are soft i think I wouldn't change them but simply address the skin envelope - i.e revise the mastopexy to try and get better symmetry......

Connie Hiers, MD, FACS · Answer

Your tissue is not supporting this size and may bottom out again. I would suggest going down in size, Tightening the capsule, and using mesh for support.  Heavy textured implants can bottom out like smooth, and textured implants have more long-term risks.

Kenneth R. Francis, MD, FACS · Answer

Dear Vaxxzz,
I have stated many times on this forum that breast augmentation combined with breast lift is one of the most challenging operations in plastic surgery.  It brings the variables of 2 different procedures to the table at the same time.  Aaaand it combines 2 opposing forces that work against each other, the stretching of skin needed for augmentation and the tightening of skin needed for breast lifting.  Speak to your surgeon about this fact and consider downsizing your implants.  Good luck!

Mats Hagstrom, MD (license on probation) · Answer

This response was dictated using Word recognition.
My apologies for any potential grammatical errors.
Without taking the breast lift into consideration, there are three variables that determine the outcome of breast augmentation surgery.
The first is patient candidacy. The second is implant selection. The third is the surgeons ability to put the implant in the correct anatomic location.
In order to make an accurate assessment regarding the outcome of any plastic surgery procedure we need to see equality set up before and after pictures.
If you don’t have before, and after pictures, then ask your surgeon to forward the pictures they took.
 From that picture, you included a few things stand out.
The first is that you have significant breast divergence, especially under right side.
This is related to your candidacy and should’ve been discussed during your consultation.
Patients who have pressed divergent are going to have the divergence put on display or amplified with the projection of the implant.
This cannot be corrected by the surgeon.
The surgeon cannot move the breast on the chest wall or change the divergence angle Almost all people the left breast will sit higher on the chest wall than the right side.
The position of the press on the chest wall, determined by the position of the IMF(infra mammary fold) it’s important to not violate the IMF during surgery.
Opening up the IMF to make room for implants that have a greater diameter than the natural diameter of the breast increases the chance of the implants bottom out.
On your picture, you’re right breast has started bottoming out.
Whenever patients have problems with breast dog medication, we can almost always trace the problem back to one or more of the above three variables spread.
In your case, the nipple pointing sideways is related to your candidacy for the procedure. The implant bottom out is related to the third variable or the surgeons ability to put the implant in the correct anatomic position.
The bottom out is also related to an implant selection.
Anytime, excessively large implants are used the chance of having undesirable side effects, complications and need for revision surgery is increased.
 I’m not saying that your implants are excessively large, but generally speaking, the bigger the implant the more likely it is to have issues like implants out.
Correcting bottomed out implants is technically difficult and should only be done by surgeons who have a proven track record, correcting this deformity.
If it’s not done correctly, the condition will recur requiring more revision surgery.
 Correcting the bottomed out implants can be done using permanent sutures with or without mesh or cadaver dermal products.
Whether you stay with your current provider or you opt to select a different plastic surgeon is up to you.
When vetting plastic surgeons you need to get confirmation that the provider has extensive experience for whatever procedure is at hand.
 For the first procedure the operation was breast augmentation with a lift.
Now your operation is correcting bottomed out implants.
You should ask whatever surgeon you select to open up their portfolio and show you their entire collection of before and after pictures of previous patients who had this deformity .
If your surgeon can’t show you evidence that they’ve corrected this problem before with a high degree of success and you may need to look for someone who has.
The fact that your implants bottomed out from the primary procedure relatively early tell me that your surgeon may be lacking in skill or experience.
If the surgeon wasn’t able to do an augmentation without having you bottom out and maybe that surgeon doesn’t have the skill to correct the deformity.
 I try to be careful saying negative things about other providers.
We’ve all had complications every single one of us.
I tried to be patient advocate in all my encounters, including responding to these questions.
Provider selection is ultimately the most important variable.
In the hands of the right provider, the chance of having high-quality outcomes without the need for revision surgery is higher.
 Ideally your surgeon should’ve mentioned your breast divergence and that is going to impact your Out, during your in person consultation.
I always recommend patients have multiple in person consultations before selecting providers.
It is the patient’s responsibility to vet the provider in regards to skill and experience for whatever procedure they are about to have.
The biggest mistake I see patients make is having only one consultation and then scheduling surgery.
Having only one consultation, more or less eliminates the ability to select a better provider.
There’s no correct number of consultations needed to find the right provider.
The more consultations you scheduled the more likely are to find a better provider for your needs.
It is also the patience responsibility to vet the provider in regards to skill and experience.
Patients need to take an active role in questioning the provider like they’re hiring someone to do a service for them, which is exactly what you’re doing.
The divergence is going to stay there, but your implant position can be improved.
I’ve done correctly. You should be able to have one revision and then have a long-term quality outcome.
If done poorly, the bottom out implant will recur requiring more surgery.
Each time somebody has become more complex and the chance for further complications increase try.
 in the end provider selection is the most important variable.
Best,
Mats Hagstrom MD

Should I consider swapping my smooth implants with textured? (photos)

Answers (7)

More Breast Implant Revision Questions

WE SEND PRETTY
EMAILS

Answers (7)

More Breast Implant Revision Questions

Do I need a crescent lift or more? (Photo)

Breast implant revision - do I need to have the capsule removed?

Can you go from sub glandular for 8 yrs to sub muscular then back to sub glandular 11 months later?

Will I have rippling with a 200cc saline implant? (Photo)

Breast implant revision to fix symmastia?

WE SEND PRETTY EMAILS

WE SEND PRETTY
EMAILS