Pocket revision and implant exchange: I want upper pole fullness, not saggy melons. (Photos)

Hello,Round smooth implants have a tendency to drift over time, especially larger and high profile implants, and sometimes rather quickly as in your case.  The simple solution frequently chosen is to have bigger and/or more high profile implants placed, only to be in the same situation afterwards. The notching you see is the implant bulging below the attachment of the muscle to the sternum; your implants are too low, and adding back more implant won't help. You really need to see a few ABPS certified/ASAPS member surgeons expert in revision breast surgery. I cannot tell you exactly what needs to be done, other than some form of pocket modification - capsulorrhaphy/mesh reinforcement. Consideration for implant selection should include switching to textured and possibly smaller devices.  Finally, there may need to be some modification of your soft tissue envelope as well (mastopexy).  All of this would be determined by physical examination. Best of luck!

You will need a revision with a lift and possible ADM sling to hold your breasts up in place.  The implant selection should be based on a combination of your desired size, soft tissue dynamics, breast base diameter and skin elasticity.  I recommend an in-office examination as well as a detailed discussion with a surgeon who you are comfortable with.   Finally, make sure your surgeon is a Double-Board Certified Plastic Surgeon certified by the American Board of Plastic Surgery (ABPS), a member of the American Society of Plastic Surgery (ASPS), a member of the American Society of Aesthetic Plastic Surgery (ASAPS), and a fellow of the American College of Surgeons (FACS).Best,Dr. DesaiBeverly Hills Institute for Aesthetic Plastic SurgeryHarvard Educated, Beverly Hills & Miami Beach TrainedDouble Board-Certified, Double Fellowship-Trained Beverly Hills Plastic Surgeon

It look as though the implants have shifted downward with loss of upper pole fullness. The remedy for this may be a multiple things. Capsule work , mesh, fat-grafting and a mastopexy. The best thing you can do is see multiple consultations with board certified palstic surgeons. I hope this helps

Thank you for your question, and I'm sorry that you have to undergo a revision.  A large portion of my practice is dedicated to performing revisionary breast surgery. Obviously an in person exam is important to establish a final plan of action.  Based on your pictures, you would need to have an implant exchange to a larger ultra high profile silicone implant, a lateral and inferior capsulorrhaphy (suturing of the pocket), and lollipop mastopexy (lift). I completely disagree with made opinions expressed below that suggest that you can get the result that you would want without performing a lift.  You have a significant drooping of skin known as pseudoptosis and this does not respond well to capsulorrhaphy alone. Typically, placement of mesh implants did not help the capsulorrhaphy or change the result. Additionally, I would also like to fix the indentation on the right upper quadrant of your abdomen by releasing scar tissue and fat transplantation.  I hope this helps and wish you well.

Without knowing what size your implants are, they appear to be on the large side and you have bottoming out. This means that your body has not been able to make a strong enough capsule to hold them in place. For that reason, pocket revisions with a capsulorrhaphy may not work. Consider adding mesh such as Galaflex for long term internal support.

 Thank you so much for the photos and we all can certainly see what you’re talking about and why you have concerns! Your before pictures just didn’t look as if you would have that much difficulty keeping your implants a pill… But you do. We often talk to patients needing revision surgery about implant exchange, capsule work, or breast tissue tightening.  My guess without an examination is you may need all three....  I know that sounds very discouraging but for you to get the fullness and perkiness you want, it may require that. I’m sorry we cannot all be more specific but take your time and find a surgeon who has a large revision experience!!!

Thanks for your question. If you are wanting upper pole fullness and more roundness to your breasts with better cleavage, you would have to either go with a substantially larger implant - 200 to 300cc larger, which I don't recommend for your body size, or do a full lift. The lift is the only way that the bottom tissues can be tightened to force the implants higher and more in the center to give you the shape you desire.

You would most likely need to do an internal pocket revision called a capsulorraphy, with a breast lift and an implant exchange. I would recommend you look into either Allergans highly cohesive implants or Mentors newest implants. Both are designed to provide the most upper pole fullness on the market without having to switch to a saline implant. Best of luck!

Thank you for your pictures and questions. Sorry to hear you are not happy with your results. Your postop photos show a very reasonable result given the pre-op photo and the surgery you had. I think the issue here is lack of communication about your goals. You would benefit from a consultation about a revision which will likely require implant exchange, mastopexy, and pocket revision with possible mesh support. Discuss this with your plastic surgeon.Best of luck!

Dear Bcb2810az,it is hard to tell for sure without an examination but you will most likely need a breast lift and implants in order to achieve the best results. Determining whether you need simply a breast augmentation versus a breast lift can be somewhat complicated. It depends on a number of factors including skin laxity and current nipple position. Generally speaking, if the nipples are lower than the inframammary line the patient will most likely need a breast lift. If the nipples are at or above the inframammary line we can generally get by with just a breast augmentation depending on the size of the implant the patient wants. I often still using implant when I perform a breast lift because it provides more upper breast fullness after the lift. I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.Daniel Barrett, MD, MHA, MS 
Certified, American Board of Plastic Surgery  
Member, Am. Society of Plastic Surgery