Unfortunately, you have not told us your
beginning bra size. 550 cc implants are
large and weigh over 1 lb each.
Currently, your breasts are asymmetrical in size, shape and position. I recommend a new technique called Implant
Exchange with Mini Ultimate Breast LiftTM. Using only a circumareola incision it is
possible to reshape your breast tissue creating upper pole fullness, elevate
them higher on the chest wall and more medial to increase your cleavage. At the same time, your implants can be
exchanged for smaller ones. Aligning the
areola, breast tissue and implant over the bony prominence of the chest wall
maximizes anterior projection with a minimal size implant. Small round textured silicone gel implants
placed retro-pectoral look and feel more natural, are more stable, less likely
to ripple or have complications needing revision. Implant profile is irrelevant in the
retro-pectoral position since the muscle compresses it.
Gary Horndeski, M.D.
Thank you for the pictures.
I don't believe that replacing the implants with others will be the answer to resolve this. You simply have the skin laxity type in which the weigh of the implants are the ones the take over. If you change the implants, the possibility of them sagging again will be the same.
Yes a revision of the lowered place of the implants via suture and ACDM mesh could help. But understand there are NO guarantees and quite an expensive surgical event.
The implants can be supported by acellular dermal matrix to prevent bottoming out. I wrote the chapter in Annals of Plastic Surgery on breast augmentation revision on this topic.
Kenneth Hughes, MD
Los Angeles, CA
It seems from your photos that your surgeon lowered your fold. This structure is very important in supporting implants as heavy as yours. You need to find a doctor experienced in restoring that structure if you want to get that look.
Larger implants such as yours are more likely to drop, so adding support with an internal bra makes sense. Options include Strattice and SERI Scaffold, a purified silk material. Saline implants will not help but perhaps textured gel implants may be more likely to stay.
You do appear to be bottoming out and would benefit from creation of a neopocket and use of an ADM to prevent it from occurring in the future
Thanks for the question and pictures. It appears that you have "bottomed out" (nipple to fold distance has stretched out), LT>RT. I agree with both the use of ADM (acellular cadaveric matrix), Strattice and conversion to a high profile saline implant, which has the same base diameter as your chest and filling it to the outer range, in order to increase the projection of the breast. Remember a saline implant will always project (stick out further from the chest) more than an analogous volume silicone gel implant. The largest Strattice Contour 3 is designed to support a 550cc implant. I would recommend keeping within this range, because despite using an "internal bra" technique, your breast skin has already demonstrated their inability to support a large implant. In optimizing size, shape, position, you must consider longevity of the result as well. Good luck.
I am sorry to hear about/see the problems you are having after breast augmentation surgery. I think your concerns are reasonable; your breast implants do seem to sit quite low on your chest wall, consistent with breast implant displacement ("bottoming out”).
It is probable that you are feeling the implants significantly along the lower poles of the breasts. Patients in your situation often complain of discomfort in the area of implant malposition. Also, consistent with the breast implant positioning problem, the nipple areola complexes seem to be sitting relatively high, because the breast implants have settled too low.
I think you will benefit from revisionary breast surgery which will likely involve capsulorraphy ( internal suture repair) possibly utilizing acellular dermal matrix for additional support.. This procedure serves to reconstruct the lower poles of the breasts and prevent migration of the breast implants too far inferiorly. Associated issues with positioning of nipple/areola complexes should improve with this operation.
Make sure that the plastic surgeon who does this procedure for you can demonstrate significant experience with revisionary breast surgery.
I hope this, and the attached link, helps.
Thank you for your pictures. You can use STATTICE® (internal bra) to help support your implants. I do not think that switching to a textured implant will make a difference. Additionally, you might not need a larger implant because once you reposition them internally they will look fuller. You will have to accept a long incision at your crease for all this to occur. Good Luck
Earl Stephenson, Jr, MD, DDS, FACS