Implant revision for bottoming out now have rippling and deformities. Is my only option removal?

Question

BA in 2002 Mentor Hi Pro sm rd Saline (375cc?). Revision Aug 2019 for bottoming out and for lateral displacement when laying down. Revision doctor replaced implants with Mentor MemoryGel sm rd mod plus profile 400cc. He preformed capsulorrhaphy with dissolvable internal sutures, closed the capsule lateral and inferior, opened medial and superior. 14 weeks post op there is significant rippling and deformities. Revision doctor offers no options except implant removal. Are there any other options?

Gary M. Horndeski, MD · Answer

You are very thin and have very little breast tissue.  Your implants are relatively large at 400 cc and they weigh almost 1 lb each.  After 2 failed attempts, it is time to come to the conclusion that implants may not be the best solution for you.  The alternative I recommend is explantation and lift using The Bellesoma Method.  The implants are removed, your breast tissue is reshaped creating upper pole fullness, elevated higher on the chest wall and more medial to increase your cleavage.  Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained, if not injured during your previous surgery.  Later, fat transfers can be performed if additional volume is desired.  Best Wishes,Gary Horndeski, M.D.

Nelson Castillo, MD · Answer

Thank you for sharing your question and photographs.  It appears that your implants are above your muscle and the overall balance of your natural breast tissue to implant is low.  This is resulting in the increased visibility and palpability of your implant.  As a result the best option is to reposition the implant below your chest muscle and possibly add a skin substitute for greater tissue thickening.

Daniel Barrett, MD · Answer

Dear AZ03,
I understand your concern and it is quite normal to be concerned about the outcome following a breast augmentation surgery. However, you are still in the very early stages of the healing process.Your will need to be patient at this moment and follow what your surgeon has instructed you to do post operatively.At the early stage of the healing process, the tissues around the implants are still swollen. Once the swelling subsides and the implants drop to their final position, you will be able to see the final result of your breast augmentation surgery. In case it persists, fat transfer might be an option.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Kenneth Hughes, MD · Answer

Visible rippling can be improved by placing the implant under the muscle, switching to Gummy Bears, fat grafting to the breast, or the addition of a dermal matrix. It's difficult to offer an opinion without seeing you in person.

Connie Hiers, MD, FACS · Answer

I would suggest going smaller and using a dermal graft like Alloderm to help support your tissue. A fat transfer could also be helpful in the upper breast areas where you are thin.

Hilton Becker, MD · Answer

There are several options available to you before considering removal.Replace saline implants with smooth silicone  gel moderate profile plus or XConsider smaller implants.Fat grafting to thicken the skin flaps.Use of a dermal matrix or mesh to support the implant Breast lift to support the lower pole

Camille Cash, MD · Answer

I'm sorry to hear of all the issues you have been having with your implants.  Removing your implants is not the only option, but a revision will be needed to improve the rippling.  As you appear to be thin you may consider having the implants placed beneath the muscle to help disguise some of the implant characteristics.  The gel implants are a better choice than saline for you, as they tend to ripple less and feel more like natural breast tissue.

Tom J. Pousti, MD · Answer

I am sorry to hear about your concerns after breast augmentation surgery. I have found that severe breast implant rippling (present in your case) is best treated with revisionary breast surgery. Breast implant removal surgery is not the only option.Maneuvers such as conversion to sub muscular positioning (if the current breast implants are in the sub glandular position currently), adjustment of the overlying breast implant capsules (capsulotrraphy), use of acellular dermal matrix for additional breast implant coverage, and the use of the most highly cohesive silicone gel breast implants possible may all be helpful maneuvers.

Best to seek consultation with well experienced board-certified plastic surgeons who can demonstrate significant experience helping patients with complex revisionary breast surgery. Expertise and experience matters.

Best wishes.

Best to seek consultation with well experienced board-certified plastic surgeons who can demonstrate significant experience helping patients with complex revisionary breast surgery.   Expertise and experience matters.

Best wishes.

Sybile Val, MD - Account Suspended · Answer

Looking at your photos, it appears you have very thin skin.  Consider having smaller gel implants repositioned to under the muscle, and possible placement of dermal matrix such as Strattice added for reinforcement and thickness.

Implant revision for bottoming out now have rippling and deformities. Is my only option removal?

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