Why did my implants not drop and fluff, do I need a revision? (Photos)

Question

I had a BA 2.5 years ago. I was super excited to get them but now I regret ever getting them done. I did 585cc gummy bear implants, under the muscle. I was told that eventually they would drop so I waited and nothing. Now I am left with no underboob and loose hanging skin I feel like my surgeon should have also done a lift. He mention a lift but then said I would eventually need to have one but not now. What could have caused my breast not to drop? Is this my body's fault or is it my surgeons fault?

John J. Corey, MD · Answer

Thank you for your question and photos and I certainly understand your frustration. I think there are a couple of factors at play but I think a comprehensive approach can really get you where you want to be. and I also want to pre-apologize for kind of a lengthy answer! First of all… What happened? I always say to make the proper treatment you need to make the proper diagnosis.  I didn’t see your “before” pictures but I I think your anatomy was such that it presented some challenges to common breast augmentation. I think you have a constricted inferior pole, meaning a very tight or stubborn  crease underneath your breasts giving a very short distance from your areola to that crease. And adding to that, I think your tissue right there is more dense. Now, in an ideal result the implant should provide fullness to the breast in the lower pole (underboob as you called it!) BUT the two factors that I mentioned above make it harder for an implant to be able to do this ESPECIALLY from behind the muscle. For this reason, in patients has  like you I will either place the implant completely above the muscle and treat it almost like a tuberous breast or I will make the incision at the areola and do a full release of the breast tissue off the muscle in the inferior pole and really open that space up, and then divide the muscle up much higher so that the bottom half of the implant is above the muscle and the upper half is below the muscle. Otherwise, that tight, constricted fold will just keep the implant sitting way too high, like what you are seeing. Now add a pretty big implant, like 585cc and now it’s even harder for the implant to drop. So for a solution, I see where it is tempting to say you might need a lift... but I think your implants are so high, making your breast so out of balance that it is really difficult to say whether you need a lift or not. The top of your implant is almost under your collarbone ! So I think you need a very aggressive release of the inferior pole, recreation of the pocket and possibly a smaller implant and then the determination can be made as to whether you need a lift or not. I would say first, get your implant in the right place and I think once it is, you may not need much of a lift at all!!! Again so sorry for the long answer but I hope it helps!

Nirmal Nathan, MD · Answer

Dear gianna1485,Thank you for your question. I don't necessarily think your implants are too large...but you do need a lift. Consult with a board certified plastic surgeon who should be able to guide you to the results you want.Good luck,Nirmal R. Nathan, M.D.
  
Certified, American Board of Plastic Surgery
  Member, American Society of Plastic Surgeons
  RealSelf Top Doctor

Gerald Minniti, MD, FACS · Answer

You were not a good candidate for a breast augmentation without a lift, and the implants you chose were far too large for you anatomy. You'll need to down size and get a formal breast lift.

Daniel Barrett, MD · Answer

Dear gianna1485,
breast revision surgery is the most difficult plastic surgery procedure performed. Botched breast surgery alters normal tissue planes and laxity, the ability of breasts to heal properly, and leaves scar tissue that dramatically affects the level of difficulty of the corrective surgery.Many patients come in to correct poor outcomes from their initial surgeries. The most common problems are due to implant malposition, bottoming out of the implant, poor scarring, and incorrect implant size.While the type of revision required will depend on the result of the previous surgery and the desired result of the patient, some revisions involve extensive pocket repair that may or may not need specialized external bras.If you are considering breast surgery revision, you should speak with a board certified plastic surgeon and have yourself properly assessed. Only after a thorough examination you will get more information and recommendations. Also, you have to make sure that your surgeon understands your breast augmentation goals.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Frederic H. Corbin, MD (license restricted) · Answer

Sorry for your problem but it can be fixed.   So get your records and prepped photos and go on some complimentary consultations with experts and compare recommendations.   That said it looks like you would have benefited from a lift from the getgoDr Corbin

Richard P. Rand, MD, FACS (retired) · Answer

You had a form of tuberous or constricted breasts and have a short distance from the crease to the lower edge of the areola. That means you will never and can never get "underhang" because there isn't enough skin down there to get that. Your result is exacly what would be expected from the starting point your body brought to the table. This is not a case where you didn't "drop and fluff". You just need a lift to move the nipples higher up onto the breast implants.

Why did my implants not drop and fluff, do I need a revision? (Photos)

Answers (6)

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