Breast implants dropped after pregnancy/breastfeeding; incision too high? (photos)

It looks like you need a pocket correction to improve the position of the implants. Best of luck with your decision to move forward.

I am sorry to hear about your concerns after breast augmentation surgery.  It looks like you have "double bubble" and breast implant bottoming out appearance after breast augmentation surgery and subsequent pregnancy. A "double bubble" is a cosmetically undesirable circumstance for patients with breast implants, which occurs when the breast fails to take on the shape of the implant, resulting in the appearance of a visible line showing a separation between the bottom edge of the implant and the bottom edge of the natural breast.   Double bubble "deformities" may be more striking (visible) when breast implants have bottomed out. The deformity becomes more striking with pectorals muscle flexion.





There are several options when it comes to revisionary surgery to improve your outcome.  One option is to eliminate the pull of the pectorals major muscle either by completely releasing it or by suturing the muscle back down, thereby placing the breast implants  in the sub glandular position.  Patients who choose to have breast implants placed in the sub  glandular position should have enough breast tissue coverage to allow for this conversion. There are disadvantages of placing breast implants in the sub glandular position (such as increased risk of breast implant encapsulation) which should be considered as you make your decisions.







Another maneuver that may be helpful is raising the inframammary fold using capsulorraphy techniques. In my practice, this type of repair involves a two layer, permanent suture repair (reconstructing the inframammary fold areas). This procedure serves to reconstruct the lower poles of the breasts and prevent migration of the breast implants too far inferiorly.  Radial incisions along the lower breast poles might help to reduce the deformity as well. Associated issues with positioning of nipple/areola complexes should improve with this operation.  Sometimes, depending on the patient's anatomy, breast lifting may also be necessary.  In other words, once the "foundation" (correct breast implant position on the patient's chest wall) has been established,  the overlying breast tissue and nipple/areola complexes may need to be adjusted (usually moved superiorly) as well.







Sometimes, depending on factors such as quality of skin along the lower breast poles, additional support provided by acellular dermal matrix or biosynthetic mesh may be very helpful. I have also found the use of acellular dermal matrix very helpful in cases where the skin/tissues are very thin and in cases of recurrent breast implant displacement. The acellular dermal matrix helps improve contour, improves irregularities caused by the underlying breast implant and/or scar tissue, and provides additional support ("sling" effect) for the breast implants. I hope this, and the attached link, helps. Best wishes.

Hello. Thank you for your inquiry and congratulations on your surgery! You could benefit from a lift.

It is important to have an in-person medical assessment regarding this issue as it is difficult to determine virtually. Continue to update your doctor in the matter and follow their post-op protocol.

Please ensure to get cleared by your doctor before engaging in specific physical activity before the 3 month healing period has ended as the healing stage is crucial for healthy results.

It generally takes around 6 months to a year to see your final results. Your tissues will take time to relax and allow your implants to "Drop and Fluff" settling into place. Should a revision cross your mind, it is best to wait at least 6 months to a year before doing so.

Our tips for recovery following breast augmentation are to wear a supportive sports bra for 3 months post-operative and refrain from lifting anything heavier than 10 lbs for 3 weeks as we don't want any strain at your incision sites. Make sure to keep the area of your stitches clean by cleansing with hydrogen peroxide daily. Showering is encouraged! But, no sitting in water for 2 weeks following surgery (no baths, hot tubs, pools etc.).

Please note that this response does not substitute patient-doctor relationship. We welcome any and all patients seeking advice to come in for a complimentary consultation available for limited time only.

During the COVID-19, we are offering complimentary online consultations as well as in-office consultation with social distancing and masks. Procedure done in-hospital private surgical facility while taking covid-19 precautions. We utilize UV-light to clean the air of viruses and bacteria during our consultations and surgery. We invite you to come in to discuss your options more thoroughly. Please send us an email at info@drkaraplasticsurgery.com with the subject line: "Attention Meagan" and we will be happy to coordinate your appointment!
M.Kara,MD,FRCSC (27+ years experience) - Specializing in 24 hour recovery/ out to dinner breast augmentation in-hospital private surgical facility for your added safety and peace of mind

A double bubble happens when the breast implant bottoms out.When a breast implant migrates below the original placement location with the bottom of the implant just above the infra-mammary crease, we call this “bottoming out.” There are several causes of this downward migration of the breast implant. Usually, some attempt had been made to lower the crease to accommodate a breast implant whose base diameter is larger than would otherwise fit in the natural breast. In doing so, the anatomic attachment of the skin of the breast to the chest wall can be obliterated. There is then nothing to hold the implant up. With the weight of the implant, and constant gravity, maybe lack of support by lack of wearing a bra continuously, the implant can settle downward. One of the earliest symptoms, I see in patients seeking revision,has been the feeling that the breast has to be constantly adjusted or just feels heavy. We look for the incision line, which was previously placed at the crease, to have migrated upward onto the breast. When we see this early on in the postoperative phase, it will never get better with time and will require a secondary repair. While some plastic surgeons may rely on suturing techniques only, I have found that unless we un-weight the implant by making it smaller or strengthen the tissues below by making them less stretchy, that the same implant, with  just sutures placed on the bottom of the pocket, will, over time, recur it's bottomed out position. I have used part of the capsule as well as the lining of the deep muscles and tissues over the ribs in the capsule beneath the breast implants to rotate upward to hold the breast implant in a higher position and therefore obliterating the extra space that has been created between the correct infra-mammary crease and the one created by the downward displacement of the implant. I call this a three flap technique, as the skin, the capsule and fascia (lining of muscles), as well as a dermal flap all contribute to creating a hammock like support of the lower portion of the pocket. When these tissues are insufficient to hold the implant up, or a previous attempt has been made with sutures, I will oftentimes rely on the addition of another type of tissue called an acellular dermal matrix of which my preference is Strattice. This Strattice ,or pigskin, does not stretch and can be sewn in to the bottom of the new location of the crease to support it just like a hammock would. Although this is costly, I consider this an insurance policy against having to redo this again. I would recommend that you try and find a plastic surgeon with experience in revisionary cosmetic breast surgery. Good luck.