Lateral Displacement and Flex Distortion of Implants? (photo)

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

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