What Do I Do Next? My Implants Seem to Be Getting Much Smaller and Are Distorted, Tight, and Painful when I Use my Pecs.

I am 3 months post BA with a peri areolar incision and silicon implants. I had mild asymmetry preop.1breast is much larger \ lower than other.I have been seen twice for pain / swelling at bottom of this breast.Doc says its normal with no contracture. The last two weeks it seems like my breasts have shrunk greatly.My muscles displace my breasts and distort them. Under the large painful breast and at the nipple my breast puckers when my pec contracts.I am unhappy and unsure how to approach my doc.

Doctor Answers 8

Breast implant revision surgery

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These problems will not resolve on their own so you are going to have to approach your surgeon at some point. Without knowing all the details or seeing the before surgery photos it is impossible to know how much of this was present before surgery or magnified/minimized by surgery. The best way to do so is calmly sit down with him or her and state the problems as you have here-puckering with muscle movement and asymmetry in the absence of a capsular contracture. Ask for a time frame and plan of action.

I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship in order to know if this assessment is valid.

Los Angeles Plastic Surgeon

Asymmetry of breasts and animation issues

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Animation issues are fairly common with submuscular implants. It would be interesting to see your pre-op photos as well to determine how much asymmetry you had.

Gel augmented breasts changing with retracted scar?

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All surgeons should be striving for the best results possible because in this age of social media, patients are empowered with their honest opinions and facts (your results) and you should be able to bring your concerns up to your surgeon without feeling any hesitation.  A good surgeon will listen to your concerns and let you know what can be done to fix the problems.  Knowing your surgeon's revision policy is important because of situations such as yours.  Your surgeon has the best idea of why you are experiencing what you are and best prepared to fix it.  I personally would want a better result for myself and my patients.

Breast Asymmetry

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I would have liked to see a pre-operative picture of your breasts, however since this is unavailable I will comment without it. If the breast asymmetry is only present on muscle contracture and the breasts appear normal otherwise, I would not advise additional surgery. If the asymmetry persist with relaxed muscles, one might consider further release of the lower pole of the left breast. Breast distortion with pectoralis major contraction is normal.

Robert J. Mirabile, MD
Philadelphia Plastic Surgeon

Distorted tight and painful under muscle implants

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It could be that the pocket was not released as much as needed, however there are some who just have too much distortion with muscle flex to make submuscular augmentation a comfortable option. If you are unhappy enough revision to a subglandular pocke might be your solution

Submuscular implants and pectoralis movement

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You have pectoralis pull in both breasts. Part of the problem is you had a very short nipple to IMF distance pre op. This can be improved by releasing the pectoralis muscle and the scar around it. If this does not correct it enough, you can have the implants placed above the muscle which will correct it 100% of the time.

Breast asymmetry after augmentation surgery.

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Thank you for your question. It is always difficult to give advice just from a short story and not being able to perform a phyiscal exam. None the less I will try. Since you have silicone breast implants, it would be highly unlikely for them to "shrink". There is normally immediate post operative swelling after surgery, the muscle also stretches and you are now adjusting to the new size, all of which contributes to you current  perception of size. The distortion around your right nipple incision is most likely from incisional scar contraction. I would recommend vigorous massage 3-5 day for at least 3-5 minutes. As for the apparent asymmetry of the breast volume and location of the implants, you have several options(exchanging implants, internally lifting or Iowering the breast crease and/or removing the capusule on the lower half of the left breast). However,  I would definitely make a follow up appointment with your surgeon and ask him his advice on to improve the symmetry. I usually perform revisional surgery in the 9-12 month post operative time period, thus allowing scar maturation, final seating of the implants and after a direct conversation of all risks and benefits.


Breast implant distortion with Pectoral Muscle contraction is norm with submuscular implants

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What you describe is usual outcome of submuscular implants.  Natural breasts are formed in front of muscle all the time.  Why should implanted breasts be any different?

Subglandular implants are preferred method of enlargement in many practices inclding mine.  I would recommend change of implant pocket to front of muscle and your issues should resolve.

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.