Breast Aug with Failed Revision- Why does this keep happening? What options do I have? (photos)

When a breast implant migrates below the original placement
location with the bottom of the implant just above the infra-mammary crease, we
call this “bottoming out.” There are several causes of this downward migration
of the breast implant. Usually, some attempt had been made to lower the crease
to accommodate a breast implant whose base diameter is larger than would
otherwise fit in the natural breast. If not done correctly, the anatomic
attachment of the skin of the breast to the chest wall can be obliterated.
There is then nothing to hold the implant up. With the weight of the implant,
and constant gravity, maybe lack of support by lack of wearing a bra
continuously, the implant can settle downward. One of the earliest symptoms, in
my patients, has been the feeling that the breast has to be constantly adjusted
or just feels heavy. We look for the incision line, which was previously placed
at the crease, to have migrated upward onto the breast. When we see this early
on in the postoperative phase, it will never get better with time and will
require a secondary repair. While some plastic surgeons may rely on suturing
techniques only, I have found that unless we un-weight the implant by making it
smaller or strengthen the tissues below by making them less stretchy, that the
same implant, with just sutures placed
on the bottom of the pocket, will, over time, recur it's bottomed out position.
I have used part of the capsule as well as the lining of the deep muscles and tissues
over the ribs in the capsule beneath the breast implants to rotate upward to
hold the breast implant in a higher position and therefore obliterating the
extra space that has been created between the correct infra-mammary crease and
the one created by the downward displacement of the implant. I call this a
three flap technique, as the skin, the capsule and fascia (lining of muscles),
as well as a dermal flap all contribute to creating a hammock like support of
the lower portion of the pocket. When these tissues are insufficient to hold
the implant up, or a previous attempt has been made with sutures, I will
oftentimes rely on the addition of another type of tissue called an acellular
dermal matrix of which my preference is Strattice. This Strattice ,or pigskin,
does not stretch and can be sewn in to the bottom of the new location of the
crease to support it just like a hammock would. Although this is costly, I
consider this an insurance policy against having to redo this again. I would
recommend that you try and find a plastic surgeon with experience in
revisionary cosmetic breast surgery. Good luck.

Dear Luna,   Thanks for submitting your before and after pictures and sorry for your problem.   From observing your pictures, it appears that your surgeons used the infra mammary incision for entry . This entry incision , makes it very difficult to correct well and consistently the excessively low sub mammary crease.   I have been in practice for 29 years, and based on my experience with many situation like your, In my opinion,  the sub areola incision is much better approach to perform inferior capsulorrhaphy (internal bra ). That is because the procedure can be done under direct vision !  Additionally, not all results are the same, because experience and skills are critical for good outcome.  Another possible reason for the bottoming out is superior pole capsule contracture , that is pushing the implants downward. In that case, superior capsulotomy ( scar release ) is indicated, in order to prevent recurrence.    Medial capsulotomy will be needed too,  for giving you a much nice cleavage, which, again, can be done easier through sub areola incision.    Always, consult with experienced board certified plastic surgeons who do lots of redo breasts augmentation in accredited  surgery center for your safety. Most importantly, check the before and after pictures in the photo gallery, to make sure that they are numerous, consistent and attractive.                         Best of luck,                                           Dr Widder

LunaMarie,Thanks for your question and for the photos.  Sorry your revision surgery failed.  You need an internal permanent suturing of the inframammary crease.  This should support the breast implant and restrict the downward progression.Best of luck.Dr. T