Reimplanting over the muscle with a smaller implant? (Photo)

Dear Hopeful199,
I almost always place implants submuscular. It lowers the rate of capsular contracture significantly. In addition, it looks much more natural because the muscle provides covering over the implant so its not as round on the top. I've also noticed the implants drop less over time when they are protected under the muscle.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Advice based on photos alone is never as good as in-person examination, but based on your photos I would suggest that you definitely do have enough tissue to go above the muscle with your re-augmentation. It’s important to choose someone with expertise in revision procedures because you’re at risk of malpositions like bottoming out. Whether it’s worth correcting the asymmetry of the arrows really depends on whether you’d prefer a scar to the size mismatch but in either case it’s a conversation worth having with your surgeon once you choose them. Best of luck!

I think you could get a great result with a subfascial augmentation. I prefer to reinforce my subfascial augmentation with a dissolvable mesh to prevent tissue stretch and stabilize the implant.
A further discussion would be key to identify what you didn't like and what your goals are to try to get it right this time.
It looks like your scar healed better after the revision. I might suggest doing the augmentation first and seeing if and how the areolar stretch. If it's not as good as you'd like then you could do a small areolar reduction under local.
An in person exam could change this opinion but there are options and think you have optimal anatomy to get a great result.

Don't cheat yourself with a circumareolar reduction; by revising the vertical scar too you'll have the best chance at soft tissue symmetry. If you really didn't want to go subpectoral (again?), you could consider subfacial, but you risk implant visibility or palpability early in the post surgical period.

Thank you for your question. A large portion of my practice is dedicated to breast revision surgery, and I have been in practice almost 30 years. Please do not make a bad situation worse by placing implants on top of the muscle. I have a whole gallery of poor outcomes from chronic changes associated with implants on top of the muscle. You have a fairly straightforward and easy fix in someone who is experienced with Breast revisions. Whoever did your surgery was Not talented. You should be able to have an excellent outcome. Best wishes to you.

Currently, your breasts are asymmetrical in volume and shape. The areola position is close to matching. You have not told us your breast size or your goals in terms of volume. The implants can be placed in front of or behind the muscle depending on what you are trying to achieve. Larger implants will have more complications due to the heavier load. You are better off with smaller implants. An areola reduction can be done on the larger one or expansion of the smaller one.

Best Wishes,

Gary Horndeski, M.D.

I would suggest staying behind the muscle for better upper breast fullness and coverage of the implant. You might consider going somewhat smaller and with a moderate plus or moderate profile. Sometimes the low profile implants are too wide for your breast base.

Based on your posted photos, I agree with your assessment of having a re-implantation in the dual plane location with a Areola breast lift To gain more symmetry and reduce the Areola. Expect fees to range from $6000-$12,000 depending on type of implant sailing versus silicon gummy’s. I recommend high profile implant by the way best of virtual consult with regards