Waterfall deformity or capsular contraction? Will a pocket revision fix this? (Photos)

Dear Terrific,

It’s unusual to see two different implant profiles (moderate plus on one side and high profile on the other), as this creates asymmetry in base width and projection from the start. A more balanced revision often begins with selecting implants of the same footprint and projection to ensure symmetry.
In your case, pocket modification (tightening or shifting the implant space) along with implant exchange to matched profiles could address much of the asymmetry you’re seeing. The decision to move from under-the-muscle to above-the-muscle placement, or to switch to a teardrop implant, depends on your tissue quality, thickness, and degree of support. These are details that can only be fully evaluated during an in-person consultation with a board-certified plastic surgeon.

Warmly,

Earl Stephenson, Jr, MD, DDS, MBA
ESJ Aesthetics — “Where Confidence Takes Shape!”

Dear Terrific132670,

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

This is a complex challenging case with unclear problems/issues just based on the photos. It appears that the left side may also have capsular contracture; in addition, to the other notable issues such as periareolar scarring around a widened flattened areola, over-released pectoralis muscles, poor scarring, thin tissues/skin and minimal fat. Changing from a submuscular pocket is not an option for you given how minimal your soft tissue envelope is. I would heavily recommend proceeding with extreme caution. You truly need to see a breast revision expert American Board of Plastic Surgery certified plastic surgeon. Your revisionary surgeon will likely include extensive breast pocket work (if not complete capsulectomies if there is capsular contracture), placement of new implants, use of internal support (i.e. Galaflex), and another breast lift.

Post-truth surgeons intend to rewrite scientific history and background knowledge, it is a non controversial fact, from the 90s, that smooth implants are associated to high rates of capsular contracture, bottoming out and seroma, due to their poor performance during tisular integration; the golden standard are anatomical shaped ones, cohesive gel filled and textured at the shell; I believe subfascial is less aggressive, safer, quicker recovery achieved, etc, but in dual plane it is also fine.

See in the link below similar cases to yours.

First of all, for a better evaluation, it would be helpful if we could see your preoperative pictures as well.

Based on the photos we see, one assumption is that you had significant asymmetry in both breasts preoperatively. This could be because the photos suggest that two different procedures were likely performed on your two breasts. The left breast probably underwent a lift and augmentation.

Of course, with a physical examination, we could determine if there is a capsular contracture in the left breast, which I find very likely.

Changing the implant placement level, that is, from submuscular to subglandular or using a dual-plane technique, I do not believe will help, nor will placing a teardrop-shaped implant.

The correction can be done by reconstructing the pocket, making it wider, restricting the pocket in the upper pole, and extending it in the lower pole. Again, your two breasts will not be identical, but they will be much more symmetrical than they are now.

One of the most important things I show my patients when we look in the mirror together is the presence of her natural or baseline symmetry before surgery, No 2 breasts match perfectly...so Id be inetredted to see what your "before" pic looks like.

That said, you have more skin, greater laxity, and more volume on your right than left. An exam would be necessary, but you may also have capsular contracture on your left.

Surgery to restore better balance depends on your desires. A lift and implant exchange with removal of scar tissue are probably going to be needed.

Your breasts are asymmetrical in volume, shape and position. Asymmetry is the most difficult thing to correct. Implants above the muscle often have a higher risks of capsular contracture. Tear shaped implants are often textured, which are associated with BIA-ALCL and you want to avoid these implants. You may benefit from placing a smaller implant in the larger breast and redoing the pocket of the higher breast. If capsular contracture does exist then the capsule may have to be removed, released or a new pocket placed.

Best Wishes,

Gary Horndeski, M.D.

Tough to know without examining you, and getting more history. Were they symmetric in the immediate post operative time frame? In other words, have they changed to this current look? Options would include capsulectomy, with or without pocket change, and re-augmentation (I’m not a fan of textured implants so I wouldn’t offer teardrop implants). I wish you well.

It's difficult to advise without knowing more of your history and seeing your preoperative photos. You have size and shape asymmetry. Is this how you looked after surgery or have the breasts changed? I encourage you to visit a few board certified plastic surgeons to discuss your goal look and consider options.