How to go bigger safely? Revision? (Photo)

Your implants have bottomed out and this is one of the reason your scar is now no longer in the inframammary fold but sitting on your breast.
The surgical management of bottomed out implants is technically challenging and not simple or straightforward. The outcome is highly dependent on who does the procedure. Sometimes the correction can be done using reinforcing sutures, and sometimes using either mesh or cadaver dermis like a Alloderm can help support the position of the implant.
The inframammary fold may look slightly unnatural early after the revision. Usually it improves with time. Increasing the size of the implant at the same time may be pushing the envelope, and you should have a thorough discussion with the surgeon who is planning on doing your revision surgery about this.
The most important variable is provider selection.
Plastic surgeons who are good at breast augmentation should not have problems with implants bottoming out. Sufficient pectoralis muscle needs to be maintained to not allow the implant to slide down below the inframammary fold.
Make sure your surgeon has done this procedure many times in the past with high-quality outcomes. Ask them to show you numerous before and after pictures of previous cases that they were done.
The time to be critical of plastic surgeons is during the vetting process when you’re choosing providers. To find the best provider, I suggest patients have multiple in person consultations. During each consultation, ask each provider to open up their portfolio and show their entire collection of before, and after pictures of previous patients who had similar body characteristics. Revision of work is not nearly as common as primarily procedurs.
For primary procedures and experience plastic surgeon, should not have any difficulty showing you the before, and after pictures of at least 50 previous patients for a commonly performed procedures. For revision, work providers may not have nearly as many before and after pictures to show you.
Being shown a handful of pre-selected images, representing the best results of a providers career is insufficient to get a clear understanding of what average results look like in the hands of each provider.
Revision surgery is generally more difficult and more complex than primary procedures. The situation you have is particularly challenging to treat well with good aesthetic outcomes with long-term success, avoiding, repeat revision surgery.
Choose your provider well, then have faith in that providers ability. There’s no correct number of consultations needed to find the right provider. For complex procedures that are technically difficult the importance of provider selection becomes far greater. I often suggest patients consider having at least five consultations before choosing a provider. The biggest mistake most patients make is not being sufficiently selective and having to few consultations before scheduling surgery.
Best,
Mats Hagstrom, MD