Do the irregularities after explanation represent the original inframammary crease and/or adhesions? How to resolve? (photo)

This is commonly seen in the setting of an explant where the initial augmentation was performed in a constricted lower pole where the fold was lowered initially. This can a challenging revision which will typically require re-operation with excision of lower pole excess scarring and re-suspension of the tissue at the higher native fold. Fat grafting may also play a role in softening the transition.As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Based on the photographs, this is not an uncommon appearance after implant removal.  It appears that the skin and breast tissue have stretched out.   In my experience surgery to release the scar without re-implantation is not successful.

You most likely have some scar tissue there.  You may need to have the scar tissue removed and/or fat grafting to help the lower breast contour.

Thank you for your purchase. I'm not really sure why fat grafting overtime would not be helpful along with scar release. I was multiple consultations to try to get a consensus on what would be the best method for you.

This is one of the problems of removing implants that have been in long term and when there is not a lot of native tissue.  This can be loose skin, it can be capsule issues, and you may not be able to correct this without replacing an implant.

I see exactly what you are referring to but zi can't give an exact answer without an exam. It looks like there is still capsule inferior to your original crease that has maintain a pocket and prevented your tissues from retracting up completely.  I suspect you need that redundant pocket, capsule obliterated so the skin below your original cream can retract down.  It looks to me like at your original augmentation they corrected for a tight constricted inferior pole by making this lower pocket.  I would get rid of that lower pocket and reset your high original pole to put you back to your starting point.  Again to be sure I would need to see you in person, but zi think this would give you back your original small and perky Breast.  I hope this helps. 

It's hard to know without seeing what you looked like before your implants but maybe you can answer that - does the area above the indentation correspond to the lower portion of your native breast tissue, and does the lowest part of the fullness correspond to where the inferior (lower) portion of the implant was?  If so, then that's exactly what you're seeing."Fixing" it can be challenging.  The best way to minimize it is by reinserting implants or doing fat injections.  Neither is necessary a perfect solution, and you've already indicated that you're not interested in that.In theory, removing the lower portion of the capsule and sewing that off to obliterate the space should improve the appearance.  But the reality is that that is a difficult procedure to do without leaving other, though hopefully less obvious, irregularities.  It is simply not that precise a procedure and some components of it - such as the scarring that occurs with any surgical procedure and certainly one with as much exposed internal tissue as you would have with this - is not completely predictable.You should see a few more surgeons in person - but it may be reasonable to revisit fat injections if you don't want another implant.  Or you may decide to just leave it alone.Either way, I hope that this has helped and good luck,Dr. Alan EnglerMember of RealSelf100