Hello,I am sorry to hear of your problems, and I wish I could say that this has never happened to any of my patients. However, there were a number of factors that may have come into play that got you to this point. I will detail them for the sake of those reading this post as well, and some may not apply to you.The things we can control include the choices we make prior to surgery. You are thin, so I presume your initial breast tissue was relatively small. The choice of implant size is crucial to achieve a long term good result while minimizing the risks of rippling, capsular contracture, and malposition. Determining the best size is called dimensional planning, which measures breast tissue size and elasticity, and it should be prioritized over their aesthetic goal in all potential patients. It is possible that had this been done for you, a smaller implant would have been chosen. The type of implant also has an affect on outcome, especially in the long term. Saline implants have a greater physical impact on your tissues than silicone gel implants, causing more unpredictable stretching and thinning, things that lead to malposition and rippling. Saline implants tend to ripple more than silicone gel, even in normal tissues that are thin. There has been enough good scientific evidence that shows that incisions make a difference. Time and again, the periareolar incision has been shown to lead to the highest rates of capsular contracture, as well as leading to other aesthetic problems (areolar scar tethering and tissue thinning below the areola). The inframammary incision has the lowest rates of capsular contracture, and does not violate the mammary gland or 'button hole' the pectoralis muscle belly. Despite this compelling information, surgeons in the California area use the periareolar incision frequently, and sometimes exclusively (while inframammary incisions are used most frequently in the rest of the world).After breast augmentation, the use of prophylactic antibiotics prior to any non-sterile procedure like teeth cleaning or Pap smears is recommended to prevent contamination of the implant during the brief period of bacteria that is release into the bloodstream. This helps minimize late term capsular contracture. Unfortunately, revision surgeries like capsulectomies are even less likely to result in a problem free result than the original surgery. This is important for everyone to know; complications can lead to uncorrectable/partially problems, or new problems after revision surgery. In other words, revision surgery puts you at risk for needing a revision surgery.Your photos show disruption of the origin of the pectoralis muscle from the sternum with significant midline shift of the implant and rippling on the affected side. Additionally, your unaffected side is just a few years behind the problem side, and any repair of the problem implant should also include repair of the 'good' side to avoid a repeat of your first revision surgery: new asymmetries. While it would be imprudent of me to give you the 'exact procedure' to fix your issues based on two photographs, I would imagine it would involve asymmetric repair of the implant scar capsules, reduction of implant size, and the use of textured, form stable (gummy bear) implants. Depending on the exact type of repair of the affected implant's pocket, the use of an ADM like Strattice might be considered, if capsulorrhaphy was chosen. As a side note, an ADM would not be chosen to minimize rippling, something that the data has shown they do poorly.I wish you the best, and hope this gets fixed well.
