Why Can't I Get Normal, Round Results?

Had first surgery 2/2010 moderate profile 305cc. Had revision in 8/2010 by same surgeon. First time there was no fullness on top, right breast was going towards arm, and left was falling past crease. 2nd revision-I have fullness on top, they looked deformed, there is no implant on bottom just hanging skin, nipples are low. Why is this happening?

Doctor Answers 8

Implant selection and subfascial placement

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There are two things that create the undesirable aesthetics.  Firstly the implant base width appears to be too narrow for your chest wall dimensions.  Secondly you have undesirable lateral inferior stretchning that is very common with dual plane placement.  Placing breast implants under the muscle creates a few aesthetic problems. If you look at your picture, your breasts are too far apart at midline to have a natural appearance.  any time your arm moves this appearance will widen and worsen.  This is the reult of releasing the inferior portion of the pectoralis major muscle.  The more superior origins will not allow the implant to sit in a natural place and the continual forces of the muscle constantly push the implant down and out.  When this is combined with excessive undermining of the inframammary fold, the deformity that you are seeing results and continues to progress.  This is a very common finding with submuscular placement.  To understand these forces better, stand in front of a mirror topless, put your hands on your hips and push down onto your hip bones firmly.  You will see both breasts move down and out.  these forces over time always cause lowering, lateral displacement, thinning of the breast tissue and stretching of the skin.  This is the reason that I use a unique technique in my practice called 'cold-subfascial augmentation.' THis technique leaves the muscle alone and out of the equation but should not be confused with 'above the muscle' which I would also not recommend.  The cold-subfascial augmentation harnesses the strong structural power of the pectoral fascia to create a truly natural breast shape and act as a living structurally sound brassiere inside the breast protecting the breast from the pressure of the implant and forces of gravity.

I have seen many patients with identical problems to the one you present and in my opinion there is only one good solution- changing placement to a new cold-subfascial plane.  All of the native inferior support of your breast is now violated and conventional techniques like capsulorrhaphy and neosubpectoral placement rely on structurally unsound scar that will surely stretch and recur.  There are several mesh and biological products people use to restore support but these in my opinion do not offer lasting support or add new risks or unnatural feeling/appearance.  In my experience, revising breasts such as yours with a subfascial plane can create a more beautiful and lasting augmentation then your original before the problems started.  I hope this helps! 
All the best,

Rian Maercks M.D.

You ned bigger implants or lift

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You do not look deformed .Your implants are sitting high and breast tissue falling off the implant. You also do not have the nipple projection. You have large nipple aerola complex and this in is consistent with previous pregnancy or weight loss . You had much bigger breast during the pregnancy and the implants need to fill your breast back to that size . If you do not want to be very big,then you need to have lift.

Breast Shape after Breast Augmentation

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It is difficult to assess completely, but it appears that you need a breast lift to give you the shape that you desire.  As was mentioned previously, any breast asymmetry that is present preoperatively may be worsened postoperatively.  This is probably what you are seeing with regards to one nipple pointing in one direction compared to the other one.  Best wishes.

Luis Zapiach, MD
Paramus Plastic Surgeon

Breast implant visibility: golf and volley balls versus silk sheets and comforters.

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I know this is a crude example but it helps to make the point. If you hide a golf ball (implant) under a silk sheet (tissue), the appearance will be very ball-like. However, if you hide the baseball under a thick comforter, the thickness of the comforter will greatly influence the result.  A very thick comforter may make the ball barely visible. The comforter will determine the overall appearance of the result. If you change the golf ball to a volley ball, it may appear more round.

In your case, you have alot of breast tissue which is acting independent of the implant mound. While the implant may be high, your breast tissue is low. They are acting as two separate entities.

Breast augmentation

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Everyone has some asymmetry before and after surgery.  Without an exam it is hard to say what can be done for you.

Results from different surgeons

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I would have to say you do not look deformed and that this is not necessarily a bad result. The issue really is what you started with before surgery and what you expected to see/achieve after surgery. Based on what we start with we cannot reach a certain end result with a specific patient no matter what surgical technique is performed and which surgeon does it. From the surgeon's stand point it can be hard to accurately depict to the prospective patient what the actual end result will be or know that they have an accurate picture of it in their head. When the expectations do not meet the result we have an unhappy patient even if the surgery and result are average or above.

Aaron Stone, MD
Los Angeles Plastic Surgeon

Getting the Results You Want with Breast Augmentation

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First of all, you don't look "deformed" and your result are natural without signs of particular postoperative problems.  However, this may not be the "look" you were going for with your decision to proceed with surgery.  Your anatomy is key in determining what your options might be.  If you want a higher and rounder look, then you need a high (or maybe even ultra high profile) implant combined with a lift to give you that kind of look.  You must be clear with your surgeon and since this happened twice, it seems that there might be some issue in that area.  Bring in photographs or get a second opinion, but your current results are both natural and free of obvious issues.

Best of luck

Vincent Marin, MD, FACS

San Diego Plastic Surgeon

You might need a lift

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If you are bottom heavy with low placed nipples you might need a lift as the implants won't lift you, just make you bigger.  Check back with your surgeon and ask about this.

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.