Why does my surgeon keep telling me my implants look great? What exactly is wrong? (photos)

Dear missmarch,    Thanks you for submitting your before and after pictures and your goal pictures. I am extremely sorry for your terrible complication. Is your surgeon board certified plastic surgeon ?  It is quite embarrassing professionally and your depression is very understandable.   You did not provide your chest circumference measurement in inches, which is critical for implants size selection. In your before pictures you appear small A cup size with mild ptosis and your goal pictures appear to be DD cup size.  Let's assume that you were 34 small A cup size originally. 800 cc implants will bring you to 34 DDD, which is quite larger than your goal pictures. 650 cc implants are more suitable for 34 DD.    You have to understand that for a person with 34 small A cup size, even 650 cc is too big for one procedure (not enough room)  and most likely , the prudent way would have been to do it in 2 stages, starting with 450 cc implants.    In your particular case, if you were my patient, I would have recommend a mini lift (donut, Benneli) with the augmentation, in order to give you perky and youthful breasts.  Unfortunately , your surgeon declined to do it (or, you refused to do it) and tried to lower the crease substantially, to create a perky look. For that maneuver to be successful, the crease has to stretch, however, it is unpredictable and in your case , it did not happen, creating the double bubble deformity. Here is what I would recommend to do:   1. Replace implants to 525 cc size (or 450 cc) , which will give you 34 D cup(or 34 full C cup).   2. Medial and superior (possibly also lateral) capsulotomy (scar release) to soften the breasts and hopefully reduce the pain.  3. Bilateral mini lift , for perkier  breasts and smaller, more attractive areolas.  4. Inferior capsulorrhaphy (internal bra) to raise the crease and eliminate the double bubble deformity.  5. In 6-12 months, you can increase the implants size to 650 cc or more.   Always, consult with experienced board certified plastic surgeons who operate in accredited surgery center for your safety. Most importantly, check the before and after pictures of redo breasts augmentation in the photo gallery, to make sure that they are numerous, consistent and attractive with nice cleavage, perky, symmetrical and natural looking.                              Best of luck,                                                 Dr Widder      

The flexion animation that you have is likely related at least partly to the double bubble. Because the crease that defines the double bubble pulls up when you flex, it is caused by the muscle adhering to the skin due to the way the muscle is cut for the dual plane method. This cannot be corrected by pocket repair alone. Converting to the split muscle plane will correct it. Because your implants are so large, the heavy sensation that you have is related to lack of support. Consider a Strattice internal bra for that.

This is a defined complication after surgery that is unfortunate,

There is not one way to fix it, however.

A smaller size will help the repair. I would take out the old implants and suture down the muscle. This could be used in the future if needed. The new implants would go on top of the muscle. This will completely get rid of the double bubble. The new implants can be an anatomic shake and smaller.

This is one option. You will get other opinions that also work.

Consultations- plural are needed.

Best wishes!

Dr Chris Saundrrs

Thanks for your question and multiple photos. Based on the info you provided, you have multiple issues that need to be corrected. You obviously have bottoming out of your implants on both sides which is your main concern. I think your "goal" pictures are not in your best interests as they are just too big and ultimately, too heavy for your petite frame. It's difficult to say more than that without an exam in person. At this point, I would recommend removing your implants and restoring your inframammary creases (folds under the breasts) which have been disrupted by your second surgery. These folds appeared intact after your first surgery. Once these folds have been fixed, if you want to have the implants placed back in then it's fine but you will definitely need to use smaller, more realistic sized implants which will not put so much pressure on your repaired inframammary folds.  Because of the somewhat short distance from your nipples to your inframammary folds, your nipples/areolae will NOT be centered on your large implants.  This is something you have to be ok with or else don't get another BBA. It maybe helpful at this point to get several opinions from other board-certified plastic surgeons who do a lot of breast work. Best wishes!

you have a double bubble because the implants are too big for your frame and foundation of your breast.  You need a pocket repair and probably a downsize of the implants. An ADM like Strattice may help reinforce the fold as necessary. The animation deformity is an issue but there are pros and cons to changing the pocket to a sub glandular position.

I am sorry to hear about your concerns after breast augmentation surgery. 

 As you likely know, you have "double bubble" and breast implant bottoming appearance after your revisionary surgery. A "double bubble" is a cosmetically undesirable circumstance for patients with breast implants, which occurs when the breast fails to take on the shape of the implant, resulting in the appearance of a visible line showing a separation between the bottom edge of the implant and the bottom edge of the natural breast.   Double bubble "deformities" may be more striking (visible) when breast implants have bottomed out.



 



There are several options when it comes to revisionary surgery to improve your outcome.  One option is to eliminate the pull of the pectorals major muscle either by completely releasing it or by suturing the muscle back down, thereby placing the breast implants  in the sub glandular position.  Patients who choose to have breast implants placed in the sub  glandular position should have enough breast tissue coverage to allow for this conversion. There are disadvantages of placing breast implants in the sub glandular position (such as increased risk of breast implant encapsulation) which should be considered as you make your decisions.







Another maneuver that may be helpful is raising the inframammary fold using capsulorraphy techniques. Sometimes, depending on factors such as quality of skin along the lower breast poles, additional support provided by acellular dermal matrix or biosynthetic mesh may be very helpful. I have also found the use of acellular dermal matrix very helpful in cases where the skin/tissues are very thin and in cases of recurrent breast implant displacement. The acellular dermal matrix helps improve contour, improves irregularities caused by the underlying breast implant and/or scar tissue, and provides additional support ("sling" effect) for the breast implants.



I hope this, and the attached link, helps.



Best wishes.

It appears that your breast is unable to accommodate an implant that large. Despite wanting to achieve a certain look, there are limitations to how large an implant it will be technically possible to fit, without causing undue complications.  Have a frank discussion with your surgeon about the obvious problems with your result and see what he recommends.  Correcting your current situation may require interventions other than just replacing your implants with smaller ones. If your surgeon does not acknowledge that there is a problem with your result, I would recommend that you get another opinion. 

From your photographs you have what we would call “double bubble”. A double bubble forms usually when some attempt is made to place an implant whose base diameter vastly exceeds that of the native breast thus necessitating a lowering of the fold. When the attachment of the skin fold remains attached to the skin, and the implant is in a plane lower than that, to bottoms appear. The upper one is where the old crease was in the lower one represents the bottom of the implant. The repair of the situation will oftentimes necessitate removal of the very large implants and placement of a smaller base diameter implant usually with the addition of some type of  ADM such as Strattice or Galaflex. If you have lost faith in your current plastic surgeon, then you are certainly able to have consultations done with a few board-certified plastic surgeons with demonstrated expertise in revision cosmetic breast surgery. Best of luck.