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

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! 

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

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.