your photograph, it appears that in the past you have had a peri-areola
Mastopexy on the right breast. Your
implants are a bit large for your breasts’ skin envelope, and are fairly
asymmetrical, as well. Placing a smaller
implant, coupled with a breast lift (Mastopexy), will be the only way to make
your nipples point straighter and reduce the volume of breast tissue in your
axilla (under your arm). My recommendation
is to schedule a consultation with a Board Certified plastic surgeon, who will
perform a physical examination. He/she
will then determine the best solution for your individual situation.
I would recommend doing a revision procedure as one surgery. Implant replacement with gel implants, likley in a new deeper dual plane pocket that is equally centered on each side, mastopexy to tighten the skin/breast envelope with removal of some tissue from the right to even the sizes can be done. Even if six months later some minor revision procedure has to be done it will be a minor revision and if everything is fine no second procedure will be needed. If you plan this as a two stage surgery you will definitely have two surgeries and will be non augmented between the two procedures.
Speak with your plastic surgeon as you need to be examined before a definite plan can be made.
Atul Kesarwani MD FRCSC
Thank you for the question and the photo.
This can be treated by repairing the lateral portion of the pocket to prevent displacement of the implant laterally.
Since your implants are saline and 14 years old I would recommend getting new ones.
Best of luck.
While removing them and doing two operations is one way to do it, I think that it probably could be done in one operation. It looks like from the photos that you may need a lift. Best to be seen in person. Good luck.
Thanks for including a photo - this is very helpful. Augmentation revisions can be very tricky, especially if a lot of work on the implant pocket needs to be done. Given your implants are above the muscle, it is reasonable to stage the procedure as you described, then put the implants underneath your muscle when you have them replaced. Sometimes removal of implants above the muscle and immediate replacement below the muscle, especially is any other work is being done on the breast, can compromise blood flow to the nipple or breast skin. It is often worthwhile staging the procedures to get a more predictable result, although it is understandable that you would want the minimal number of surgeries.
The approach you have suggested is a very good one. The advantage of this approach is that if the implants are placed properly the second time, you will likely be in great shape and not have to worry about a recurrence of the problem.
The downside is you have to have 2 operations.
Another option which is to have the pocket for the implant surgically repaired and the implant replaced. The benefit of this is that you can potentially do this in one procedure, however the risk of recurrence may be a bit more likely.
Thanks for your question. One option is to do exactly what your PS advised; removing the implants for a time allows the surgeon to essentially start fresh. There are other options such as closing off the edge of the pocket with suture materials or other products that act like a sling to prevent your implants from moving laterally again. Each approach has distinct advantages and disadvantages so presumably your PS suggested the technique that they felt would work best in your situation, but you could ask them if there are other options.
I am sorry to hear about the problem you are experiencing after breast augmentation surgery. Based on your description and pictures, it seems like you are experiencing a breast implant displacement problem.
Generally, the lateral breast implant displacement can be corrected using an internal suture technique, decreasing the size of the pockets and moving the implants toward the midline. Doing so will prevent the breast implants from migrating to the sides when you lie down and will help centralize the position on the breast mounds. In my practice, this repair is done with a 2 layered suture technique. The use of acellular dermal matrix is an option ( although not usually necessary) especially if significant implant rippling/palpability is present.
I hope this (and the attached link) helps. Best wishes.
It is difficult to tell from your pictures, but asymmetrical displacement of breast implants over time is not that uncommon. This essentially means that your breast capsule is enlarged or very stretchable. One method of repair that can be performed in one surgery is call capsulorrhaphy. This means internal sutures are placed within the breast pocket to limit the lateral and inferior movement of the implant. This holds the breast implant in the proper location on the chest wall. There are many opinions on the timing of such a procedure, but I would consider placing these sutures at the time of surgery with or without changing your implants or implant location to a submuscular position. I don't see a reason to perform two surgeries 6 months apart, but this would also be an appropriate conservative method to treat this problem. A full examination and discussion with a Board Certified plastic surgeon will allow you to hear all of the pros and cons of each approach to determine which approach will suit you best to achieve your goals. In either case, this should be a very correctable issue with a good success rate.
Occasionally it is best to remove implants, heal and then start over. But my general plan if you are above the muscle would be to remove the old implants and start in a new submuscular pocket, repair the inferior and lateral descent and have you wear a specific bra 24/7 for 3 months to minimize any chance of recurrence. Single stage.