Breast implants bottoming out again
Thank you for asking about your breast implants.
- I am so sorry you are having these problems -
- I agree you appear to be back to square one.
- I believe you need at this point to have opinions from several Board Certified Surgeons.
- Above all the cause of the pain has to be determined and a way to correct it.
- At least in the photos, you seem to have large implants for your frame - so don't be surprised if you are told that part of the correction will include a switch to smaller implants.
Always see a Board Certified Plastic Surgeon. Best wishes - Elizabeth Morgan MD PHD FACS
The first thing to do would be to go for a few consultations with board certified plastic surgeons that do a lot of breast revision work. Most plastic surgeons do not like to take on complications from other surgeons. They are always much more challenging and never straight forward. Those of us who do a lot of them enjoy these challenges and know that it can be a difficult process for the patient. Your pictures are helpful, but without a direct examination and reviewing your medical records, it is impossible to say what will work best for you. I hope this helps.
Breast Implants Keep Bottoming Out
I am sorry to hear that you've had a rough go of things after your breast augmentation. It is very upsetting to require multiple surgeries to correct a problem resulting from an elective surgical procedure.
Revision breast work is challenging, and it must be done by an experienced surgeon who is familiar with all of the recent techniques available to fix your problem. Your main issue is that the implants keep wanting to slide down your chest past your breast fold. This may have been the result of this area being overly dissected (basically loosened up or freed up too much) when the original implants were placed. Preservation of your natural breast fold is crucial in an augmentation because it maintains normal anatomy and acts as a "shelf" that holds the implants up in the right position.
Since your implants continue to bottom out it is likely that you will need to have them placed into a new pocket. They can remain under the muscles, but it is possible to create a new plane and insert the implants into this new area, which will provide a "snugger fit." I would need to see the operative note from your second surgery to determine exactly where and how the Strattice was placed. You may or may not need an adjustment of this +/- some new internal sutures to hold the implants in the right place permanently.
The best place to start is to voice your issues to your actual Plastic Surgeon. See what he or she recommends and offers to fix this problem. It is always appropriate to seek an opinion of other board certified Plastic Surgeons as well. Best of luck!
Difficult Breast Revision
sorry your dissapointed with your results.Revision breast surgery can be challenging and requires an experienced surgeon. Each surgeon has their own approach. In your case I would exchange your implants to a Neosubpectoral plain (keeping them under the muscle but in a new plain). This will allow me to essentially start over with your breast pocket dissection. You also need more structural support at your lower breast pole with internal sutures and or more stratice. The use of stratice is also technique specific and needs to be placed appropriately. It requires experience in setting the tension.Best
I'm sorry to hear you're having such a tough go of things. The best advice I can give is that second or third opinion never hurts in this situation. The key is to see someone who has best experience doing revision breast surgery, as these cases can be quite difficult, as you well know. Considerations should be given to using permanent, non-dissolving stitches along with the strattice, and, using an under wire bra or some form of compression along the new fold for an extended time after the procedure.
Best of luck!
Board-Certified Plastic Surgeon
Newtown Square/Philadelphia, PA
From what I can see, a small touchup of tacking up of the insertion of the Strattice higher on the posterior chest wall may solve the bottom issue. Without knowing if Strattice is placed by the sternum, it to may need to be adjusted to better block the implant from pouching out there. You are certainly entitled to get a second opinion or two from other surgeons you deem appropriate. Ask to see photos of more complex repairs. A little grey hair may be better. Be aware, however, that in the new physicians eyes, you're starting all over and it may be more cost-effective to stick with the surgeon that you have. Good luck.