Is My Breast Augmentation a Result of Over-dissection of the Pocket? (photo)

My photos are pre-op and 2 years post-op. I requested a natural looking, proportionate look. My surgeon advised 475cc high profile saline implants. I am very unhappy with my results and would like to know what went wrong, and what procedure is recommended, so that I can avoid future complications with my revision surgery.

Doctor Answers 7

Unhappy Results After Breast Augmentation


Perhaps there were a few things that conspired against you from having a good result, but certainly it began with the pre-operative planning of the surgery.  There must have been a communication breakdown from the beginning if you said you wanted a proportionate, natural look, and he (and you?) choose 475cc HP implants. These are large (wider than your breast base), almost ball shaped implants that never yield a natural look.  The choice of saline filled implants also had a negative impact.  Saline implants have physical properties that are very similar to balls used in sports, especially when overfilled, and can store and release kinetic energy, driving the implants down by expanding the surrounding tissues.  This is known as the 'waterhammer effect', and is significantly less in silicone gel implants. 

Going forward in consideration of a revision surgery, the elements that need to be addressed are implant size, implant profile, correction of implant pockets, and possibly correction of overexpanded skin.  In general, you should exchange these implants for smaller and lower profile, to minimize a recurrence of this problem, and give you a more natural, longer lasting appearance. The other issues have to do with the concern of the surgeon at the time of surgery, and in the preoperative planning stage, the surgeon will determine the type of pocket adjustment, and/or the potential need for a mastopexy.

Unfortunately, your problem is considered complex, and I recommend you seek out highly experienced surgeons that are expert in revision breast surgery.  This could potentially take a number of hours in the operating room, so it is not going to be inexpensive; do not be fooled by someone that tells you this is a quick fix and quoting you a low price.  Although you are unhappy now, you should know that you can get a great result still, so do not despair. 

Best of luck!

Beverly Hills Plastic Surgeon
4.9 out of 5 stars 88 reviews

Unsatisfactory breast augmentation results.

In addition to the previous comments, you should know that the results are not entirely predictable and requesting a certain look is one thing. Promising a certain look is clearly another.  No one knows how you are going to heal the implants in place.  Thus, you may end up looking like two half grapefruits on your chest or more natural or tear drop shaped.

Todd C. Case, MD
Tucson Plastic Surgeon
4.9 out of 5 stars 55 reviews

Your result is not good, but may be much more than "overdissection."

From your photographs alone, it is impossible to state whether your present appearance is due to above the muscle implants that have developed capsular contracture (likely from biofilm formation from intraductal bacteria as the breasts were lifted off the pectoralis muscles), below the muscle implants with inadequate inferomedial tissue release and gradual muscular displacement of your implants inferolaterally (possibly associated with capsular contracture but not necessarily), as well as overfilled high profile saline implants (regardless of location) rather than wider and less-projecting moderate plus or even moderate profile silicone implants.

Lots of potential issues, and lots of additional information to be had by personal physical examination before a surgical plan of action is formulated . . .

Even if your surgeon is an ABPS-certified plastic surgeon, but especially if he was NOT, you need one or more consultations with ABPS-certified plastic surgeons who do lots of breast surgery and are experienced in dealing with these kinds of issues. You CAN have a better result, but this is much much more complex than choosing "better" implants or related to "over-dissection." Do lots of research and see enough surgeons to get an idea what is recommended and who will provide the most thoughtful plan and precise technical procedure possible. Best Wishes! Dr. Tholen

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
4.9 out of 5 stars 250 reviews

Lateral implant drift

Thank you for the questions and good photos.  I assume your implants are under your pectoral muscles.  If that's the case, then it's likely that the muscles have pushed your implants laterally and inferiorly.   If you flex your pec muscles by putting your hands on your hips and squeeze, you'll see if the implants are being displaced.  If that's the case, then the treatment is to internally repair the scar tissue capsule laterally to close off this area; exchange your implants for silicone (probably of wider diameter than the HP's)'; and transfer them to the subfascial (above muscle) tissue plane.

Victor Ferrari, MD, FACS
Charlotte Plastic Surgeon
5.0 out of 5 stars 36 reviews

You have options

First, I think you need to ask the question you asked here to the surgeon who did your surgery and express your dissatisfaction with your results.

Second, make sure you get the opinion of a board certified plastic surgeon (or a second one if your first surgeon was as well) about what options you have.

You may benefit from relocation of the pocket, use of an internal sling (like Strattice), or a switch to silicone implants or a different profile.  There are options, but all will require additional surgery. 

I wish you good luck or would be happy to see you if you are in the Columbus, Ohio area for your breast augmentation revision surgery.

Jason Brett Lichten, MD
Columbus Plastic Surgeon
5.0 out of 5 stars 18 reviews

Unhappy with Results of Breast Augmentation

I'm sorry to hear about your dissatisfaction with the breast augmentation surgery results. It is hard to comment fairly without examining you ( for example is there encapsulation present or is your situation mainly related to breast implant displacement).  you may be best served by seeking additional opinions and person;  a review of your operative report will be helpful.  I would agree with Dr. Rand's suggestion  to see well experienced board-certified plastic surgeons in your area who can demonstrate significant experience helping patients in your situation.

Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,465 reviews

Breast surgey results

I agree with you that you have a much worse looking result than I would expect from someone with your decent starting point.  Why that is, I can't say without knowing more, but you should seek expert consultation from the best local plastic surgeons where you live to discuss plans for revision.  Just from the look, you appear to have above the muscle implants that have dropped into the "ball in a sock" look. The profile looks poor, there is too much space in the middle and they sit too lateral. Good luck.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
4.8 out of 5 stars 67 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.