Scar has moved from my breast fold (Photo)

Question

I received high profile silicone implants in January 375cc I believe… my scar over the last month is now visible on top of my breast instead of underneath in the fold where the were. I have lost some fullness above the nipple. I am only 5’2 and 100 lbs. is this normal or should I speak with my plastic surgeon

Gianfranco Frojo, MD · Answer

This can occur when the incision is not planned in the correct future breast fold. This occurs because the implant stretches the lower pole of the breast and the scar gets pushed on to the lower pole. This usually occurs when implants that are too large are placed; the incision location is poorly planned; or due to the intrinsic properties of the breast tissue (such as lots of laxity and inadequate support). I recommend finding a board-eligible or board-certified plastic surgeon with at least 6 years of plastic surgery integrated residency training and ideally another extra year aesthetic fellowship accredited by the Aesthetic Society.

Wayne I. Yamahata, MD · Answer

It appears that your implants have settled in a position below your original crease or fold. As a consequence, the scar is now above the crease. As the implant is lower, there is less fullness in the upper part of your breasts. Your implants appear very large, and the weight may have contributed to this development. Ideally, you would have a revision to reposition the implants. Seek a return visit to your surgeon to discuss your options.

Jonathan Heistein, MD · Answer

Hi.  Your breast implants have something called bottoming out.  That means that there isn't enough support to hold the implants higher.  You should talk to your surgeon ASAP so that he/she can fix it before it gets worse.  You will need surgery to give more support at the bottom of your breast to keep the implants up.  This can be done with stitches or mesh.  Your surgeon can discuss the options with you.  Best of luck!

Gary M. Horndeski, MD · Answer

Your implants are large and in front of the muscle. They appear to be quite heavy and the skin is stretching out. The implants will continue to descend lower and lower. You will need smaller implants or plications inferiorly and laterally to hold the implants in place. Another option is to remove the implants and do a breast lift. I recommend 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 or small implants can be placed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Sean T. Lille, MD · Answer

Dear Enthusiastic,  
Your implants have dropped too far down and the skin has stretched. That makes your nipples at the top of your implants instead of in the middle. The lower pole breast skin can be shortened with a "horizontal mastopexy," but you may need the skin reinforced with some type of "mesh." I prefer Strattice. If the implants are above the muscle, I recommend placing them below the muscle and using the Strattice to reinforce that skin and fold, like an internal bra. Best of luck to you!!

John L. Burns Jr., MD · Answer

Your implants have "bottomed out" meaning that the implant has caused the breast crease to lower and the distance from the nipple to the breast fold is elongated and the implant is sitting too low; below the nipple.  The breast fold needs to be reconstructed and supported with a mesh like Galaflex or Durasorb.

Connie Hiers, MD, FACS · Answer

Both implants have bottomed out or dropped down below your natural fold which gives the appearance that your scar has moved up high. Your scar did not move. Your implants may be too heavy for your tissue, and you may need mesh for more support. Please go back to your surgeon to discuss this issue.

Hilton Becker, MD · Answer

Your breasts have bottomed out resulting in loss of  the breast fold 
The implants need to be elevated  fixated  and secured with an internal mesh bra

Jason Pozner, MD · Answer

Your implants have dropped past your normal fold causing a fold malposition. Correction involves repairing the fold with Galaflex or other support

Mats Hagstrom, MD (license on probation) · Answer

I think you should consider getting an in person second opinion consultation.
Your employer the bottom about badly, and this is a direct reflection of how the procedure was performed.
Correcting bottoms out implants is complex and difficult.
If your provider didn’t have the skill to get the implants positioned correctly the first time, and they probably don’t have the skills to correct this deformity.
The following are some general recommendations and guidelines to find the best provider.
There is no simple fix to your problem. It requires reconstructing the lower part of the implant to pocket. This usually requires closing the pocket using a permanent, suture and often reinforcing with mesh for cadaver dermis products like a Alloderm. 
To find the best provider, I suggest patient schedule multiple in person consultations with experienced plastic surgeons in their community. During each consultation, ask each provider to open up their portfolio and show you their entire collection of before and after pictures of previous patients who have similar body or facial characteristics to your own. An experienced plastic surgeon should have no difficulty showing you the before and after pictures of at least 50 previous patients. An experienced provider should in fact have hundreds or preferably thousands of before and after pictures to choose from for commonly performed procedures. 
Being shown a handful of preselected images, representing the best results of a provider’s career is insufficient to get a clear understanding of what average results will look like in the hands of each provider.
There is no correct number of consultations needed to find the best provider. The more consultations you scheduled the more likely you are to find the best provider for your needs. 
Take careful notes during each consultation, especially regarding the quantity and quality of before and after pictures. It’s not a bad idea to bring pictures of your own body/face to use as reference when reviewing before and after pictures. 
The biggest mistake patients make is scheduling only one consultation without properly vetting or comparing providers before scheduling surgery.
Best,
Mats Hagstrom, MD

Scar has moved from my breast fold (Photo)

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