Yes, unfortunately you have the sort of long term outcome that is the result of placing a large smooth surface implant on top of the muscle in a person with thin tissues. And you also have capsular contracture which occurs more often with implants on top of the muscle. All of these issues will make your "Makeover" a challenge.
You are correct in thinking that placing the implant under the muscle would be one part of the overall correction. On the side with capsular contracture it is usually recommended that a capsulectomy be performed, but this could be difficult in person with thin tissues, so instead the capsule could be collapsed and a new pocket created under the muscle. Switching to a textured surface implant would also be a consideration because of the lower risk of capsular contracture.
A tear drop shaped implant may also make sense as all shaped implants have a textured surface. Anyone who uses these shaped implants on a regular basis will tell you that tear drop shaped implants unequivocally look different, or more natural then round implants, in patients with thin tissues. This would be a major change for you, so staying with a round implant under the muscle will still give you a more natural appearance.
It would also make sense for you to downsize somewhat and switch to a higher profile or narrower implant to reduce the lateral fullness. Revision of the implant pocket will also help to move the implant more towards the middle of your chest and narrow the wide space, although it may not be possible for your breasts to touch in the middle.
This is a challenging case. The implants will need to be repositioned with the use of Alloderm or similar type of slings. Cleavage is created by the bra and can not be created with the implants
Large breast implant revision
You face several challenges after having very large implants in place above the muscle for several years with a capsular contracture. Your breast tissue is very thin and you need to consider with your surgeon capsulectomy, closure of the old pocket and placement of smaller implants in a partial subpectoral position. A limited or possibly a full anchor lift may be needed to reduce skin, elevate nipple position and narrow your areolae. The uplift/skin reduction surgery may need to be scheduled separately if your skin circulation is at risk after a capsulectomy. Another option that you might consider is to have your implants removed for several months to allow some shrinkage of your skin followed by subsequent placement of smaller implants (I know that you won't find that option desirable but it may be of benefit and worth considering).
Research your choices carefully and good luck.
Jon A Perlman MD FACS
Certified, American Board of Plastic Surgery
Extreme Makeover Surgeon ABC TV
Beverly Hills, Ca
Changing implants MAKE OVER HELP. Any suggestions?
Thank you for your pictures and questions. You exhibit some of the classic problems with subglandular implants over time. You have developed asymmetry as well as migration in the pocket. In general, you have the right idea, you are going to need replacement of the implant and conversion to a partial submuscular position. In addition, you are likely going to need some revisions to the implant pocket dynamics and a different choice in implant dimensions, as well as some work to correct the asymmetry. These types of cases can be complicated and require expertise. I would advise getting several consultations with a few local surgeons who are board certified by the American Board of Plastic Surgery. Only through an exam and thorough discussion can you make the decision that is right for you.
Best of luck and be safe!
Changing implants MAKE OVER HELP. Any suggestions?
Thank you for your question. To achieve a more natural result, switching the implant to a plane under the muscle / dual plane would be the way to go and would create a gentle natural slope superiorly. You would likely also need some additional pocket revision, capsulectomies and possibly a limited lift to improve symmetry. Studies have shown that patients and surgeons can't tell the difference in results between round and tear dropped shaped implants. It would be ok to stick with round implants. Be sure to consult with an experienced board certified plastic surgeon. Good luck!
You have the right general idea - silicone implants and under the muscle. But any specific decisions as to size and type of implant can only be made after a consultation and examination. Seek out an experience board certified plastic surgeon.
Revision breast surgery options
There is no replacement for an in person exam with a board-certified plastic surgeon. Having said that you have a classic problem seen with above the muscle breast implants, especially in a thin woman, capsular contracture and implant visibility. You should strongly consider breast implant revision with a site change procedure to partially below the muscle. This is a little more difficult in a woman with larger implants so you should be cared for by a board-certified plastic surgeon with experience in this type of revision. I hope this helps.