Did my surgeon did something wrong or it is bad luck? (photo)
Doctor Answers 7
Multiple revision breast surgery
Can't say without all of your op notes but I see no reason why your creases couldn't be fixed -- you'd need to wear a specific underwire bra 24/7 for 4 months and do zero pec muscle exercise and nothing bouncy like running. Are you sure your surgeon is super experienced in this and have you been a good patient? Only with both, can you get this fixed.
Breast Implant Revision
That is disappointing to hear. We don't want any patients having multiple procedures. Use the Smart Beauty Guide to learn more about breast implant regions and qualified surgeons in your area.
Choose a breast revision expert after multiple operations
A lot more detail about your prior procedures is needed in order to offer specific advice, but the general rule of thumb is that the biggest predictor of the need for a revision is a prior failed re-operation. Your next operation has to do something other than what was tried previously if you expect a different outcome, and it has to be a plan that addresses the problem. This could require reinforcement with an internal bra material such as Strattice or Galaflex.
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It is very difficult to say without reviewing all the history and performing an exam. Seeing you very first preop photos is helpful.
So, with a patient such as yourself, maybe the best plan is to remove the implants, re-create your IMF bilaterally likely with some alloderm/ADM or some other mesh/tissue matrix, allow things to heal for several months, only then consider going back to replace implants. I am guessing you have not considered such a thing, but at this point you are more or a reconstructive patient than a cosmetic patient, that is what most plastic surgeons would do in a recon situation, so prob best thing to do for you at this point. Good luck
Borrowing out: Did my surgeon did something wrong or it is bad luck?
I am sorry to hear about/see the problems you are having after breast augmentation surgery.
It is hard to advise you, without knowing much more detail, why you have experienced so many complications. Generally speaking, once a patient has experienced a complication, every operation to improve her outcome may be more challenging and associated with additional risks.
I think your concerns are appropriate; your breast implants do seem to sit quite low on your chest wall, consistent with breast implant displacement ("bottoming out”).
It is possible that you are feeling the implants significantly along the lower poles of the breasts. Patients in your situation often complain of discomfort in the area of implant malposition. Also, consistent with the breast implant positioning problem, the nipple areola complexes seem to be sitting relatively high, because the breast implants have settled too low.
I think you will benefit from revisionary breast surgery which will likely involve capsulorraphy ( internal suture repair). Sometimes, depending mainly on the patient's history and physical examination, I will also use additional supportive materials such as acellular dermal matrix or biosynthetic mesh. This procedure serves to reconstruct the lower poles of the breasts and prevent migration of the breast implants too far inferiorly. Associated issues with positioning of nipple/areola complexes should improve with this operation.
Make sure that the plastic surgeon who does this procedure for you can demonstrate significant experience with revisionary breast surgery.
I hope this, and the attached link (dedicated to corrective surgery for bottoming out concerns), helps.
Bottomed out implant
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.