Breast Placement Too Far and High One Year Out - is it Worth a Revision? (Photos)

Question

I had a transax augmentation last year- 405cc under muscle. It seems they have not dropped and are still high/wide. Is this worth getting a revision?

Warren Schutte, MD · Answer

At 1 year post op, entertaining a revision surgery to correct placement/pocket would be worth your while.

Daniel Barrett, MD · Answer

Dear Sociable476760,

I understand your concern. However, without a proper assessment, it would be difficult to determine what is wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Emre Guvercin, MD, FEBOPRAS · Answer

Hi there &mdash; what you’re describing is a very typical issue after transaxillary, under-the-muscle augmentation, especially with implants in the 400 cc range. When implants sit too high or too wide and haven’t dropped after a year, it usually means the muscle is still holding the implant in a tight, unnatural position.
At this point &mdash; one year post-op &mdash; they are not going to drop further.
Is a revision worth it?
Yes, if your goal is a more natural shape, better projection, and implants that sit where they’re supposed to. The problem isn’t the implant size &mdash; it’s the pocket and plane.
Best approach in your situation
A revision moving the implant above the muscle, into the subfascial (OTM) plane, gives a much more natural and centered result.Using Motiva Ergonomix² in full projection helps achieve: • A rounder and more projected look without being artificial • Better cleavage • More natural upper-pole transition • Correction of the “high and wide” appearance
Ergonomix² behaves dynamically and avoids the stiff, frozen look that often happens with implants trapped under a tight muscle.
Why subfascial is ideal here • Eliminates muscle distortion • Allows proper implant settling • Reduces lateral displacement • Creates a more predictable, natural drop • Especially effective in revision cases like yours

Ryan Endress, MD · Answer

Revision is really the only way to correct the placement of the implant and give you the aesthetic look you desire. The pec muscle has not been released at all medial, keeping the implants way lateral and high. I would use a small inframammary incision to convert to a dual plane and allow the implants to come farther down and centered where they should be for optimal results.

Jacob Carlson, MD · Answer

I think you could achieve a fantastic result with a revision. Based on the photos you submitted, it looks like the implants were positioned appropriately at the time of surgery - a small space at the middle of the chest where the pectoralis muscle was left attached to the sternum. I assume that, over time, the implants have more out laterally. In a revision, a surgeon could recreate the space near the center of the chest and then support the outside of the breasts to prevent the implants from moving out that direction again.
Based on the pre-op photo that you submitted, it appears that you had a narrow breast width to begin with, and the inframammary fold slopes upward toward the chest of the chest more significantly than in some other patients. During the revision, the surgeon could also ensure that the pectoralis muscle has been released appropriately along its lower border to make sure that the implant can stay in the appropriate position.

Dallas Buchanan, MD · Answer

Thank you for your questions and photos. This is the issue with trans-ax augmentation and why I do not offer it. Visualization is poor and pocket dissection is often incomplete. The muscle has not been released properly and this has lead to lateral and superior displacement of the implants relative to the breast gland. I would recommend a revision procedure through the fold to alter the pocket and possible exchange the implant. Best of luck!
Dallas Buchanan, MD
VIVIFY plastic surgery
Tampa, FL

Paul E. Chasan, MD, FACS · Answer

Thank you for your question.  You definitely would benefit from a breast revision with pocket modification.  This is otherwise known as a internal bra or capsulorrhaphy.  I wrote the very first paper and capsulorrhaphy in 1999.  I have been in practice for over 30 years and revision breast surgery is a large portion of my practice.  You should be able to have a beautiful result in experience hands.  Best wishes to you.

Donovan Rosas, MD · Answer

There are advantages and disadvantages to distant access incisions such as TUBA or Trans Ax. These incisions are easier to hide aesthetically. However, they can limit, to a certain extent pocket visualization during dissection (blind or endoscopic). They can also be limiting in terms of implant selection.

With regards to your specific question, after 1 year post op significant changes are unlikely. You may benefit from pocket revision to better release the muscle and close off the lateral pocket to better centralize the implant. It is also important to remember that submuscular implants are limited by the sternal origins of the muscle. Wide set origins will limit cleavage.

As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Sean Fisher, MD · Answer

You implants are quite far lateral on your chest. This can occur for a number of reasons, including surgical technique and starting anatomy. If the pec muscle is under-released, this can force the implants into a more lateral position. However, based on your "before" photo, it also appears that your breast position was wide-set to begin with which can also dictate medial cleavage in "under the muscle" augmentation. I would recommend scheduling a follow up with your existing surgeon if you have been happy with them or someone with a focus on revision breast surgery.
In my practice, with patients who experience this problem- I often recommend revision with an incision in the breast fold to allow re-positioning of the implants, additional muscle release if needed, or conversion to a subfascial pocket if patients are a good candidate for it. 
Sean Fisher, MD Aesthetic Plastic SurgeonSeattle, WA

Camille Cash, MD · Answer

One of the challenges with transaxillary augmentation is that the surgeon is unable to visualize the pocket.  A revision should improve your result but will likely require an additional incision.  As you are one year post op if you do nothing your result isn't likely to correct without intervention.

Breast Placement Too Far and High One Year Out - is it Worth a Revision? (Photos)

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