My surgeon and i agreed upon 600CC HP implants, he implanted 600CC MP implants. The implants laterally migrated and i got severe strech marks. I went in to see him and upon reading my chart I discovered he had implated MP not HP and he and I had specifically agreed upon HP cause they are less likely to migrate. He replaces the implants with 600CC HP and uses surgimend to fix the migration, ignoring advice of a capsulorapphy. The left breast has migrated again. How do i fix it and who's fault?
What Can I Do To Fix a Botched Breast Augmentation? (Photos)
Doctor Answers 9
You need smaller implants
Breast implants are too large disrupting the inframammary fold
I think the first mistake was choosing implants that are too large for your chest and not whether HP or MP. To put a larger implant than the pocket that can be created surgically is asking for trouble. The lower pole of your left implant cut though the inframammary fold. If you are willing to settle for a much smaller implant, say about 400 cc, then you can have the inframammry fold repaired with some support.. Good luck.
Let things settle for now.
It looks like you just had the revision surgery.
Let things settle for 3 months or so.
At that point the stretch marks may be less obvious.
You will probably still want to revise the Left side and correct the bottoming out that you have developed.
At that point I would do a capsulorrhapy with your own tissues, using the capsule itself. I would release the capsule above and tighten it below. The skin will have stretched a bit and you may be able to keep your current implants. Good luck
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Botched breast augmentation and stretch marks
There are three issues to be considered:
1. Implant size. Given your small preop shape, and it looks like you haven't had pregnancies and therefore any natural breast envelope stretching, 600cc is big. Worth considering at least a little smaller.
2. The stretch marks. These are very distressing for you, and are the most obvious negative in terms of your visible breast appearance. The good news is that they will fade over time, and will become pale and hard to see. It will take some time though.
3. The left implant position. This will need to be revised if it is not in an acceptable position for you. A capsulorraphy will be required, but might not be enough even with a dermal matrix support. If your implants are subpectoral, the appearance might well have occurred because of downward pressure from your pectoral muscle when it's being animated. Check this by standing in front of a mirror with your hands on hips and press strongly. If the implants are pushed down or distort, then in my opinion this force must be corrected during revision or it might recur. It's worth considering changing the implant plane to the subfascial prepectoral plane if there is tension banding. Patients often fear a too visible upper pole in the prepectoral plane, but it is only a problem in the extremely thin and is a good possible solution for you.
What Can I Do To Fix a Botched Breast Augmentation? Answer:
Bottoming out is very challenging and has a high rate of recurring. However I live in a land of large implants and I personally think your right breast is and was fine for your build. Had your left one not fallen, your shape and cleavage would have been fine even with the MPs and would have suggested stopping there. But now, I would fix you with a dermal matrix (I use Strattice) and capsulorrhapy and I suggest you go smaller, maybe 450-480. I don’t think you’ll be happy with anything smaller.
The too large breast implant
Your story and photos are typical of those who choose an implant by the number, and hire a surgeon to stuff it in. Your implants have caused tears or stretch marks in the breast skin, and pushed out of the envelope of the breast. Your implants have not migrated, they have extended under the breast with deforming results. Repairs with smaller implants can solve your situation. An experienced surgeon might have told you no at the start.
Best of luck,
Breast implant revision
The pictures show that the left breast inframammary fold is too low. This is a difficult problem to correct. I have helped patients with similar problems before by recreating the anatomic position of the inframammary fold by using permanent sutures secured to the ribs and a biologic mesh placed as a sling between the lower portion of the pectoralis muscle and the new fold. This also requires implant exchange to a smaller size because the current implant size has proven too heavy and large for the inframammary fold. There is no treatment for the stretch marks. They should improve over time however. I hope this helps. Good luck!
Stretchmarks after breast augmentation
I do not think your problem is fixable. The implants were too big and cracked the skin elements causing stretchmarks. Those cracks cannot be repaired. You actually made things worse by going to HP implants as is obvious in the photos. Where did this 600cc number come from? Did you shop for a surgeon who would do what you asked for or did the surgeon recommend the size?
It sounds like you talked the surgeon into the size of implant you wanted. In that case it is mostly your fault.
I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.
My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.
What Can I Do To Fix a Botched Breast Augmentation? (Photos)
I completely empathize with your situation and wish I had a dollar for each time I was presented with a situation similar to yours.
I hope you do not take the following as personal criticism. The responsibility for the result is shared both by you and your surgeon. Please, allow me to explain.
Like everything in life we are surround by limitations. A person going to the gym once a week for an hour should not realistically expect the results of someone who goes to the gym daily and spends 5 hours working every muscle group. A 7 foot fast footed basketball player surely will be a better player than a 5 foot player of average skill. You can stuff only so many people into a phone booth. We ALL know that.
But, it seems when it comes to Breast Augmentation the laws of physics and of common sense fly out the window. There are REAL physical limitations on how large of an implant can be stuffed under a woman's breast before the overlying breast is pressured into wasting away (atrophy) and exposing the implant, before cracks / stretch marks appear in the shiny stretched out skin and before the incision / scar are stretched out. In addition, a beautiful augmentation result requires
- the breast implant to be well covered and camouflaged by your PRESENT breast tissue (putting a wider implant means the folds of the implant will be visible and felt)
- the implant needs to be centered under YOUR nipples, regardless of where the nipples are located. Side pointing nipples will require side point breasts - otherwise, the nipples will be located on the side rather than at the apex of the breast
- the implants should sit as much as possible on the flat part of the chest to avoid the "side slide"
- Breast implants are NOT filled with Helium and are NOT immune to gravity. Without any additional weight, ALL breasts sag with age. Any weight added to the breast will hasten the sagging and a LARGE implant will result in FASTER sagging.
I am not sure WHO picked the implants - you or your surgeon but it is clear that they were WAY too large for your breasts. From my perspective, you began with small slightly asymmetric breasts. They were detached way off the chest wall to allow large and mismatched implants to be put in with, unfortunately, predictable results. The breast skin was stretched and cracked resulting in the marks you pointed out. The weight of the implants resulted in predictable sagging.
Unfortunately, there are no Mulligans or "do overs" in Plastic Surgery. Each operation results in scarring and altered blood supply further complicating subsequent operations and making them slightly less predictable.
Educate yourself on all your options. You can live with this result for a while until these implants leak or you may have them revised. I would strongly recommend you at least consider smaller implants but will probably benefit from placing a "biological" hammock such as Strattice under the implants to brace their sagging as well as add more cover.
Peter A Aldea, MD