Need help finding my next breasts! I've had my under muscle breast implants for 10 years and they need a lot of help! (Photos)

I am 35 and just lost 60 lbs from my last pregnancy. I have had 4 kids and nursed them all. The implants I currently have were not done very well but I was happy enough. Now, I have a large gap between my breasts, they are lopsided and my nipples are quite off. I am training to hopefully compete in a fitness competition by next year but I need my breasts put over the muscle and I need a tummy tuck before that can happen. I need help, advice, information, recommendations, referrals, etc. Please?!

Doctor Answers 11

Breast Fix, Under/Over Muscle?

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Ultimately you will need to have an in person consultation before any specific recommendations can be made. Also your photos were taken with your arms raised which distorts the implant and breast tissue position making it difficult to assess what is going on. Since your implants are at least 10 years old I am assuming that they are most likely saline. That would be consistent with the way the implants appear to have migrated toward your armpit with an increasing large space between your breasts. Switching to a new generation highly cohesive gel implant would be a good option for your revision.

Others have stated that they think you have capsular contracture but I am not so sure about that. Your implants look quite round but that would be a typical appearance of a larger saline implant with thinned tissues. Your ? right implant looks quite low and that would not be consistent with capsular contracture. Your ? left implant is higher so you might have capsular contracture on that side which, if present, will complicate the revision. 

You indicated that you want to have your implants placed on top of the muscle. Perhaps that is related to your desire to participate in a fitness competition. There both pluses and minuses for having your implant either under or over the muscle. Given the position of at least one of your implants I doubt it is even under the muscle right now. One of the problems of putting an implant on top of the muscle is that the implant will thin your tissues.  Your tissues already appear to be thin and putting the implant on top of the muscle will thin your tissues even further and this would not be to your benefit. It will make more likely that you could develop visible rippling and it will also increase the risks of doing a breast lift which is also something you will likely need. 

It is useful to think of your revision surgery as requiring two significant components. First will be the implant which needs to be repositioned and possibly downsized. This will require modification of the internal implant pocket and putting in a new implant. The second part of the revision will involve lifting your breast and elevating and moving your nipple position inwards. This will require some type of mastopexy or breast lift. Given that your tissues are thinned there will be some increased risk of doing a breast lift on you. 

At this point it should be evident that your revision surgery will not be simple or easy. You should definitely look for a surgeon that has lots of experience with revision breast surgery. Combining your breast surgery with your tummy tuck is possible, but there may be a limit on how much is done at time. If you think you are going to lose more weight then you should wait until you are closer to your goal weight.

Breast Implant Help and a Tummy Tuck

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You are asking a great question because it shows you are doing some research.  Good for you.  Right here on RealSelf is a good place to look for surgeons in you area.  Another resource would be the American Board of Plastic Surgery site or the American Society for Plastic Surgery site.  Both sites have surgeon finders.
You did not supply a photo of your stomach but from what can be seen you may only need a mini tummy tuck to get a flat "competition" stomach but it depends upon your goals.  
You have outlined your goals for your breasts and from what can be seen, it appears that you would need a breast lift and a revision of your implants.  Sientra's textured breast implants or gummy bear implants would be a great option as they do very well over the muscle.  Again, all of this depends upon your goals and what is seen on an in person evaluation.  
I hope that helps.
Best regards.

Brian Windle, MD
Kirkland Plastic Surgeon
4.9 out of 5 stars 64 reviews

Need help finding my next breasts! I've had my under muscle breast implants for 10 years and they need a lot of help!

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Thank you for your question and photos. Based on the photos, you have bilateral capsular contractures with the implants moved up and breast tissue sliding off the implants. You will need a re-augmentation/lift, but the concern is how thin your tissues are. This can be determined during a physical examination. It is possible to remove your implants and have the tummy tuck done with lipocontouring of your torso at the same time. The re-augmentation/lift might have to wait 3-4 months. The reason I would stage your operation is, if your breast tissues are thin you can risk loss of nipple areola complex in one or both breasts. See a board certified plastic surgeon for an in person consultation/evaluation to determine which would be the best approach in your case. Good luck.

Need help finding my next breasts!

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It does appear from your photos that you would need a breast lift. As to your implants, it appears that you have some degree of capsular contracture, which would be treated by capsulectomy and implant replacement. You say that you need your implants changed from under to over the muscle, but you do not say why. The risk of capsular contracture is higher with implants on top of the muscle, and if your tissues are thin you risk visible implant wrinkling and rippling in the upper portion of your breast. You may also have some greater tendency towards breast sagging with subglandular implants, particularly if your tissues are thin. So, if you want your implants moved over the muscle, that is fine, but you must understand the pros and cons of doing so.

Breast lift and revision augmentation

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You are a great candidate for breast lift and revision of breast augmentation. I don't recommend changing the pocket at time of mastopexy as that could compromise blood flow to the nipple areola complex. Look for a board certified plastic surgeon with experience in revision breast surgery. Best, Dr. Yegiyants

Sara Yegiyants, MD, FACS
Santa Barbara Plastic Surgeon
5.0 out of 5 stars 20 reviews

Need help - Breasts need changing

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Just looking at your photos it appears you need a Breast Lift along with your implants placed in a subglandular position (on top the muscle).

Christopher Costanzo, MD
Thousand Oaks Plastic Surgeon
5.0 out of 5 stars 40 reviews

Need help finding my next breasts!

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Thank you for sharing your question and photographs.  Though nothing replaces an in-person examination it appears that you would most benefit from an implant pocket adjustment with breast lift on your right side and a capsulectomy with breast lift on your left.  In order to minimize the chance for skin sagging recurrence, I would recommend downsizing your implants.  Hope this helps.

Nelson Castillo, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 80 reviews

My Breasts Don't Look Good - What Do You Advise?

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Obviously, an in person exam would beat evaluating three pictures.  However, it appears that your left breast has a capsular contracture which is why your breast is pushed upward and your nipple points downward.  
I'm not sure you meant to say you need your implants put over the muscle.  There is some controversy about whether implants should be put over or under for body builders or fitness contestants.  I personally like them put under the muscle, but that depends on your personal preference.  Historically, implants look more natural and stay softer if placed under the muscle.  
At this point, it would be appropriate for you to consult with several Board Certified plastic surgeons who have demonstrated on the internet expertise in both breast implant reaugmentations and lifts.  

Breast change after pregnancy

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It is important to wait on any surgery until your weight and breast size has completely stabilized.  Once this has occurred, you would need a breast lift (mastopexy) at the minimum.  It is also important to know the amount of breast tissue and the degree of capsular contracture that you have prior to deciding on the type and size of implant.  If your current implants are below the pectoralis muscle, it can be very difficult to replace the implant above the muscle and safely perform a lift simultaneously.  As always, it is important to personally consult with a board-certified Plastic Surgeon

Jarrod Little, MD
Louisville Plastic Surgeon
4.9 out of 5 stars 22 reviews

BBA Revision

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Thanks for your photos and question. Based on your desires and photo, you require is a site change your implants and a breast lift. Although I believe you can achieve excellent results, this is a tricky operation and needs to be done carefully so as not to negatively affect the blood supply to the breasts. It is important that you consult with a board-certified plastic surgeon that has significant experience with combination breast lift and augmentation. Good luck and best regards.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.