What can I do to fix my breast and is the surgeon at fault? (photos)
Doctor Answers 6
What can I do to fix my breast and is the surgeon at fault?
I am sorry to hear about your concerns after breast augmentation/lifting surgery.
It looks like you have "double bubble" and breast implant bottoming appearance after your revisionary surgery. A "double bubble" is a cosmetically undesirable circumstance for patients with breast implants, which occurs when the breast fails to take on the shape of the implant, resulting in the appearance of a visible line showing a separation between the bottom edge of the implant and the bottom edge of the natural breast. Double bubble "deformities" may be more striking (visible) when breast implants have bottomed out.
There are several options when it comes to revisionary surgery to improve your outcome. One option is to eliminate the pull of the pectorals major muscle either by completely releasing it or by suturing the muscle back down, thereby placing the breast implants in the sub glandular position. Patients who choose to have breast implants placed in the sub glandular position should have enough breast tissue coverage to allow for this conversion. There are disadvantages of placing breast implants in the sub glandular position (such as increased risk of breast implant encapsulation) which should be considered as you make your decisions.
Another maneuver that may be helpful is raising the inframammary fold using capsulorraphy techniques. Sometimes, depending on factors such as quality of skin along the lower breast poles, additional support provided by acellular dermal matrix or biosynthetic mesh may be very helpful. I have also found the use of acellular dermal matrix very helpful in cases where the skin/tissues are very thin and in cases of recurrent breast implant displacement. The acellular dermal matrix helps improve contour, improves irregularities caused by the underlying breast implant and/or scar tissue, and provides additional support ("sling" effect) for the breast implants.
In cases where an unfavorable outcomes are present it is best for patients to discuss their concerns in a calm/constructive fashion; most plastic surgeons very much want their patients to be pleased and will do everything they can to improve outcomes.
Although definitive advice would require more information, assuming you are working with a well experienced board-certified plastic surgeon, I think that it is generally best to stick with your plastic surgeon and allow him/her to improve your outcome. Most plastic surgeons take a lot of pride in their work and strive hard to achieve outcomes that their patients will be pleased with; no plastic surgeon (or outcome) is perfect and the need for revisionary surgery is a reality in all of our practices.
Again, unless you have specific concerns about your plastic surgeon's abilities to improve your outcome best to allow him to do so. If, in any doubt, it certainly won't hurt to seek in person second opinion consultations with well experienced board-certified plastic surgeons.
Best wishes for an outcome that you will be pleased with long-term.
Reasons Many Seek Breast Revision Surgery
The most common reason women seek breast implant #revisions are to change their implant #size, and, capsular contracture . Capsular Contracture occurs in about 5-10% of breast #augmentation patients. However, only a small number of these patients experience pain or visual issues that actually require correction. Additional matters of concern which many seek a revision are malposition of the implant, changes in shape and size following pregnancy, weight change and also #deflation or #rupture of an #implant. Please be advised that each patient is unique and previous results are not a guarantee for individual outcomes. As with all cosmetic surgery, results will be rewarding if expectations are realistic. With any surgical procedure, there are some risks which your doctor will discuss with you during your consultation.
Complex problem with tuberous breast, animation, and double bubble
Unfortunately there are several things going on and deciding on how best to improve your outcome will take careful analysis. First, the distortion you see when you flex your pec is called animation deformity, and is caused by detachment of the pectoral muscle. That is called the dual plane technique. It can be corrected by converting to the split muscle plane or going above the muscle (if using that approach the surgeon should re-attach the muscle.) The second issue is the double bubble, which is related to the tubular breast and the size/shape of the implants. A tubular breast means that the base diameter is narrow, so when the implant is wider it pushes beyond the base leaving a crease where the original base was. There is often very thin coverage there too so that is why you feel ripples. Converting to a form-stable implant of optimal dimensions may be worth considering as well. Finally, your periareolar mastopexy may benefit from revision with internal support such as a Strattice donut to prevent widening again.
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It is a difficult question that you have asked in "Is the surgeon at fault?". The answer is maybe. But probably not at fault for the results that you have obtained. He or she may possibly be at fault for not communicating effectively about the difficulty of your case or explaining the possibility of less than optimal results or need for revision. Or he/she may have explained things perfectly but it was not received perfectly. You were starting with a difficult problem. Your results do not seem optimal and I am sure that many of us would say that your results would be much better if you would have chosen a different surgeon or had a different procedure. But there isn't a plastic surgeon out there who hasn't had a disappointing result or wish that they had chosen a different solution to a problem.
The better question at this point is not if there is someone that is at fault, but rather is there something that can be done to improve the results. And there certainly is. But it will take another surgery at least. You likely need a pocket revision procedure to correct the double bubbles. I would suggest decreasing your implant size and completing a more formal mastopexy to more effectively correct your shape and maintain a better NAC size that is stable. You should open communication with your surgeon and express your dissatisfaction with your results. Your results can certainly be improved, but it will take open communication, patience, and trust in your surgeon to achieve the results you want.
You definitely have a very unfortunate outcome, but I wouldn't necessarily blame your surgeon as long as he or she is a board certified plastic surgeon. My correction for you would include correcting the pockets with the Internal Bra, placement of Strattice on both sides, and an implant exchange. Certainly a challenging revision so make sure whoever you chose to repair the issue is very experienced with revision surgery.
What can I do to correct my deformity?
I am sorry that you have had difficulty in healing from your chosen surgical procedure. I would agree with your Plastic Surgeon that a donut mastopexy would have been needed to correct the tuberous breast shape. Knowing that placing the implants under the muscle have healed poorly with a contracture deformity as you have a revisional procedure may require implants placed into a new submammary pocket. This would be determined after a full examination. Perhaps using smaller silicone, gummy bear round or teardrop implants may have to be considered. Possibly using alloderm material in the breast to minimize contracture may also have to be considered.
Offering an opportunity to your Plastic Surgeon, or obtaining other opinions, may be considered. Is tha surgeon at fault for creating this deformity that you currently have- not at all. The challenges were great, but hopefully can be improved.
Good luck to you.
Frank Rieger M.D. Tampa Plastic Surgeon
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.