Implant not dropping after exchange... Revision options? (Photos)

Question

I had my second breast augmentation in August 2024 with 590cc high profile sientra 107s and a left periareolar mastopexy to correct asymmetry after three pregnancies. Original BA was in 2010 with 360cc moderate profile, round silicone. I'm now a little past 6 months post-op and my left implant won't drop into the pocket. It also has migrated laterally just slightly, resulting in a nipple/areola complex positioned more in the medial half of the breast. What are my options for revision?

Daniel Barrett, MD · Answer

Dear SiliconeSongbird,

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

Gary M. Horndeski, MD · Answer

In your pre-operative photograph, you can see your breasts were widely separated with very little cleavage. After having the 590 cc implants placed, the breasts have deflated laterally and inferiorly. Although your implants may be partial under the muscle, most of it is no longer under the muscle. I recommend smaller implants as well as inferior and lateral plication to re-center the implants. You would also benefit from a circumareola approach to reposition the nipple-areola complex. The other alternative would be the remove the implants and lift the breasts higher. After 6 months, place small implants in front of the muscle.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Connie Hiers, MD, FACS · Answer

The capsule will need to be released, but I suggest going down in size for this is too large for your frame. A smaller implant will settle better and has less risk for a repeat capsule.

Implant not dropping after exchange... Revision options? (Photos)

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