9 months post explant (en bloc) & lift, how do I fix this double crease? (Photos)

Question

I am 9 months post explant (Enbloc) and lift. Unfortunately, since I took my bandages off, I have a double crease that has not gone away. When I flex, it looks like something is off with my chest muscle on one side. My original surgeon says fat transfer to that area will help fix this, but I suspect it may also require muscle repair. I don’t need perfect breasts; I just want to wear low-cut tops again. Please help!!

Gianfranco Frojo, MD · Answer

This is one of the big problems with implant removal and capsulectomies, particularly en bloc capsulectomy (which is only indicated for treating BIA-ALCL). There has been significant contracture of the previous implant space and previous capsule. All of those spaces/planes have now scared to the chest wall. This is a complex problem that needs to be approached by an incredibly experienced American Board of Plastic Surgery certified surgeon.

Daniel Barrett, MD · Answer

Dear curious gal NY,
it is hard to tell for sure without an examination. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Justin Yovino, MD, FACS · Answer

Fat transfer that that area if definitely the best approach. Fat transfer will not change the muscle but it will add volume over it and help camouflage the irregularities. These can be a bit challenging to fully improve with just one round of fat transfer. Sometimes it takes a few sessions of fat transfer. With all this said, you must have enough donor fat to transfer. Common donor areas include the abdomen, flanks, hips, waist, love handles, back, arms, thighs, and knees. A consultation and examination will help with the plan and the decision process. Non-surgical options would include Renuva but this is typically a much more subtle outcome with each session.

Gary M. Horndeski, MD · Answer

Unfortunately, your photographs are somewhat limited. The question is whether the lift was adequate. It may be possible to do a repeat lift to correct the problem. Fat transfers can be done but may have to be done several times. Also, it may not correct animation deformity. Additional photographs are needed to give an accurate answer.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Hilton Becker, MD · Answer

If the muscle moves on contraction it may need to be sutured down.
Fat grafting would be the optimum way to correct the depression .

Connie Hiers, MD, FACS · Answer

"En bloc" is a term used only for cancer surgery and removing extra breast tissue with the capsule. Just based on your photos, I suspect you had a capsulectomy instead. You are missing volume and a fat transfer, perhaps two, could be helpful to regain volume.

Gregory Sexton, MD · Answer

A muscle repair should stop the animation deformity you are seeing.
Good luck.

Greg Sexton,M.D.
Columbia, SC

9 months post explant (en bloc) & lift, how do I fix this double crease? (Photos)

Answers (7)

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