Pockets Made Too Big Implants Move Around & Hang too Low, Can This Be Corrected Without an Uplift? (photo)

Hi there-

You didn't mention, but it looks to me like your implants are on top of your muscle. The problems you are having with their appearance are characteristic and incredibly common for implants placed in this position.

The fact that they often look good right after surgery (although I realize you have never been happy), there is less pain than with subpectoral placement, and many surgeons and patients view it as a way of avoiding a breast lift make it seem like an attractive alternative... but I have found that most often, when patients like yourself present to my office, they either don't remember being told, or just weren't told, that over time the implant appearance (and therefore the breasts' appearance) would suffer for the fact that skin and breast tissue don't hold up as well against gravity as the chest muscle does.

In other words, it looks a little to me like you are now paying the price for the short cut you tried to take in the decision making at the time of your first procedure... This will only be complicated by trying to take more short cuts to your desired appearance.

If your goal is to achieve a long lasting, beautiful, round but natural breast shape, your best bet (in my opinion) is to realize that you probably needed a breast lift in the first place 3 years ago- have these implants removed, replaced with smaller ones under your muscle, and have an artfully performed breast lift.

Of course, your choices are yours to make, but please realize that the most unhappy people I see are those who look for short cuts and cheap prices.

Correcting your implant problem means revising the breast pocket that the implants are in. Correcting the breast pocket may involve moving the implant into a new position under the muscle and then possible adding in a biologic dermal matrix such as Strattice or Surgimend to help support the implant in its new position. The dermal matrix will act like an internal bra. Once the implant has been repositioned then the breast, nipple position, and shape can be re-evaluated. You may require a breast lift if the nipple complex is to low. Sometimes I will opt to forego the breast lift if a patient is really worried about scarring. Let the breasts settle down for 3-6 months and if my patient is unhappy with the look of the breasts, I will perform the breast lift.

You have implant malposition. The implants have bottomed out. There are several reasons for this but weakness of the support system of the inframammary crease or violation of the crease during surgery can be one of the causes. This can be corrected in one operation by removing your implants and using a biologic mesh like SERI to support the implant and prevent a recurrence. May also need a breast lift to reposition the breast. 

It is possible that you would benefit from tightening of the implant pockets.  If they are already too big, I would not recommend fat injections which will create an even larger appearance.

If you decide to go smaller, you may need a lift. It is hard to say without an exam.  The pocket may need to be tightened as well.

Very hard even with your posted photos to give accurate answer. I think your surgeon might have a plan but I would add a donut lift to be sure. 

You have stated that your implants are too big and move. Capsule revision will help to some degree. You are better candidate for smaller implant,breast lift and far grafting to the upper pole of the breast. I understand that you do not want the lift scar, but your breast tissue position demands lift.

These questions are best answered through a consultation with the patient in front of the Dr and all information.

But, if the implants are too large then the correction is smaller implants(or if saline some deflation can be done). If you have smaller implants you may get significant drooping that can only be corrected with a breast lift. An internal capsulorrhaphy (making the capsule smaller will help prevent the implants from moving around more but will not function as a lift. 

Thank you for the question at pictures.

Precise advice  cannot be given without direct examination but I think you may be a good candidate for revisionary breast surgery;  I think you may be able to have  capsulorrhaphy performed ( permanent internal sutures to decrease the breast implant pocket space). For example, the capsulorrhaphy can be done to prevent the breast implants from moving laterally  (into the axillary area). This procedure is likely what your plastic surgeon was referring to as “tightening the pockets”.

You also have some asymmetry of the nipple/areola positioning;  this may be able to be improved upon with closing off the space of the left breast inferiorly.

Hopefully with these maneuvers,  breast lifting surgery will not be necessary.

I hope this helps.

This is not an uncommon problem and does not have a simple and satisfactory solution for your concerns. I would agree with Dr. DeMars although this is not as simple as it sounds. 

I don't think your implants are too big, your breasts too low, and that the pocket for the implant was made too big. Your nipple position looks to be at the crease level (with the left side asymmetrically positioned) and the width of the implant fits the width of your breast. The problem is that the pocket (capsule) has stretched and is now too big for the implant such that your implants flatten and fall to the side lying down (just as natural breasts of your size do). The simplest way to solve this is to put in a wider/taller implant without altering the pocket/capsule. This can even be an implant that has less forward projection to offset the larger width volume. You definitely don't want to put in a smaller diameter implant as this aggravates the problem and adjusting down the pocket/capsule is not a simple maneuver, particularly when the implant would be too narrow for the breast width. It doesn't look like a lift will help much either. I would suggest a lower profile (smaller) implant with a wider base diameter as the simplest solution that doesn't need to actually make the total volume of the implant bigger.