What can be done for horizontal indention lines after breast augmentation?

Question

After silicone implants 210 and 225, I see a horizontal indentation (line) of at least 3 " in length, and about a 1/2" below each nipple when I raise arms to my hips or often as I raise my arms straight up. I am very concerned because it is one year later. The ptosis is somewhat improved, but both breasts remain fairly droopy. I had the Benelli procedure (no vertical lift) and paid $20,000 in total to a top breast surgeon. I am quite sad about it all. Thank you for you help . . .

Martin Jugenburg, MD · Answer

It is impossible to give you an opinion without before and after photos. Please consider re-posting. Best of luck.

Mark D. Epstein, MD, FACS · Answer

Without photos I cannot make an accurate assessment of the problem and determine its cause nor formulate a plan. A physical exam by a board certified surgeon is also essential.Drs Del Vecchio, Volpe and Morgan all raised some excellent points.if you have a double bubble this may be correctable by converting to a dual plane III procedure or a subglandular position. Fat grafting is an option also in some cases.i would suggest that you have a discussion with the operating surgeon and maybe a couple of other surgeons as well.

George Volpe, MD · Answer

Although a good exam is necessary to help determine what is causing those horizontal lines just below your areola following a periareolar lifting and augmentation procedure, there are a couple of possibilities. During this type of procedure, it is common to place a station that encircles the areola. Occasionally, this stitch may show some indentations on the skin and may be the cause of inferior lines. Another possible cause is the edge of the trellis muscle was released. One should discuss this with one's surgeon along with an exam to help clarify this.

Steven Wallach, MD · Answer

I am not exactly sure what you are talking about.  Photos would be helpful and certainly the best would be a physical exam in person. Best of luck.

Daniel Del Vecchio, MD · Answer

Without seeing photographs of your preoperative pictures everything I'm about to say is just a possibility. I am going to make an assumption that your breasts were small preop based on the small implant size. The horizontal lines could therefore represent a double bubble deformity. This can be caused by the native inframammary fold that you had before the surgery remaining persistent, and not re-draping over the convexity of the implant. Look  at your preoperative photos. If the distance from the bottom of the areola to your original underwire crease, or inframammary fold is short, 3 to 4 cm, a constricted breast may be the diagnosis. This type of problem can often be treated with fat grafting of the lower portion of the breast and release of the native inframammary fold.hope this helps.Dr Del Vecchio

Jourdan Gottlieb, MD · Answer

Photos would help.What you describe sounds like an indentation from the lower edge of the pectoralis muscle, and this is common after under the muscle breast augmentation. (Animation)  I wouldn't want to comment on the amount of sagging without a photo. An in person evaluation by your surgeon is my advice.All the best.

Thomas M. DeWire Sr., MD (retired) · Answer

Penelope,Photos would help a lot here, as would comparison to pre-op photos. This line may represent the original fold position, though 1/2 inch below the areola is pretty close to the areola to represent the original fold line, but the lift may have altered that relationship. This occurs when base dimension is expanded beyond the original breast base position, and may be aggravated by release of the lower pectoralis muscle origins, causing a dynamic deformity when the muscle is flexed (pushing inward with hands on hips), worsening the deformity, or making it appear. For this reason, I do not release the muscle during augmentation, but rather keep it as an internal bra-like support, preventing the expansion of the tissues below the lowered fold, or I avoid lowering the folds entirely.  You should ask your surgeon to evaluate this, and ask to have it corrected.  I hope that this helps.  A link below discusses breast shape after augmentation as well as addressing situations that can lead to double fold deformity.  I hope that this helps.Best wishes,    Tom DeWire, MD, FACS    Richmond, VA

What can be done for horizontal indention lines after breast augmentation?

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