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.

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.