Hello! I had a BA 8 months ago with 300 ccs silicone implants under the muscle. Do I have lateral displacement? At first I loved it, now I have NO inner cleavage and any fullness I have is near my armpits. When I lie down on my back my chest goes flat and my implants fall into my armpits. Also, when I flex my pecs, I have distortion of my breasts- they ride up from the bottom. What would fix these issues? If I get a revision- what size implant would you recommend? I am 5'5", 115 pounds, 3 children.
Lateral Displacement and Flex Distortion of Implants? (photo)
Doctor Answers 10
Pocket revision may help
You have minimal breast tissue and also very strong upper body. The placement of the silicone implant under the pectoralis has the down side of implant lateral displacement. This is more common in patients that continue upper body workout. The cause of displacement is limited release of the pectorals muscle. I do offer implant pocket revision,fat grafting to enhance the cleavage and release of the pectoralis muscle to let the implant expand the lower pole of the breast.
Implant Malposition vs Patient Anatomy
There are several points that need to be addressed. Before surgery photos may show that you have wide set breasts which the implants will be wide set (ie . no cleavage). The muscle movement comes with placing the implants beneath the muscle. Placing the implants above the muscle does solve this problem but you must have enough thickness of tissue to hide the edges of the implant.
Pocket Revision for Lateralized Breast Implants
The pocket can be revised with capsulorrhaphy sutures to block lateral migration and create the illusion of more medial fullness.
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Implant issues and lateral displacement
First, I can not tell witha bra on whether you have lateral displacement. You did not have cleavage to begin with and unfortunately, your anatomy dictates some limitations. If you have issues with lateralization , you may require a pocket revision.
Lateral Displacement and Flex Distortion of Implants?
It appears as if you had axillary incision as the site of insertion??? If true than the muscle dissection was not completed medially in my opinion. Also increase in size to 400/450 UHP is my recommendation.
Activation distortion after breast augmentation.
You are tall and slim, with very little of your own breast tissue. Swelling after surgery, as well as more medial placement of your (conservatively-sized) implants, initially gave you more fullness and cleavage. Over time, swelling diminished, tissues compressed and stretched somewhat, and your muscle (pectoralis major) contraction pushed your implants laterally, as well as giving you flexion distortion of the lower pole of your breasts.
All submuscular implants, particularly in very thin women, can exhibit some degree of activation distortion. To minimize this, careful release of the inferomedial pectoralis fibers as they attach to the sternum and parasternal tissues is performed during surgery or revision. Over-release can leave the overlying tissues extremely thin, so this is one of those skill, judgement, experience issues that we all have to deal with accordingly in each specific patient.
I agree with Dr. Repta's analysis and ideally would stay submuscular, but with larger (and wider) silicone implants to more adequately fill your pockets after additional judicious inferomedial pectoralis fiber release bilaterally. Wider (lower profile) implants may circumvent the need for lateral capsulorrhaphy (tightening the pocket on each side), or that may be still needed.
While subfascial implants (or submammary, for that matter) can solve the activation distortion problem, it potentially increases edge or ripple visibility (less with silicone implants, much more with saline in thin patients), not to mention increasing risk of capsular contracture. BIgger problems, so I too would stay submuscular, even if there is still some activation distortion present. Flexion distortion is most evident to the patient when nude, but much less so to others, even when swimming or exercising.
To make even a minimally-visible implant enlargement worthwhile, I would go up 125-150cc (about another half cup size) to 450cc implants (moderate profile). For more enlargement, add accordingly, but I would probably stay below 550cc or so. Discussion and physical examination trump any on-line advice, however! Best wishes and Happy Holidays! Dr. Tholen
Several options exist for revision
Thank you for the question and the photos. Breast animation (breast movement with muscle contraction) is always present to some extent with implant placement under the muscle. Breast animation is increased when the pocket is over dissected. During your revision the side of the pocket can be repaired (closed), the muscle over the sternum can be properly opened, and an implant suited to your goal can be replaced (wider implant). Often all of these are performed. You could also have the implant replaced in a subfascial position as this would also correct the animation aspect of your breast issue. You are fairly thin so I would go with the first option of modifying your breast augmentation but keeping the implants in the sub-muscular position.
All the best,
Dr Remus Repta
Displacement of breast implant following breast augmentation
From your description, the breast implant may becoming displaced for a number of reasons. A capsular contracture can cause an implant to be displaced up and outward. This can also occur if the implant was placed in the submuscular plane and the muscle is excessively strong and/or the muscle extends below the midpoint of the implant. If the breast pocket has stretched laterally, this can also contribute to this condition. Check back with your surgeon, after examing your situation they will probably have a good solution for you. Best wishes
Sub muscular placement of breast implants can cause lateral displacement later on
As the pectoralis muscle is engaged after sub muscular breast augmentation the vector of force on the implant can push it laterally. Over time this can become a chronic problem. Moving the implants to a sub glandular position where fixed the problem