Revision Options

I had a BA in July 2010 using Mentor HP Saline 380 CC Round Smooth filled to 450, Inframammary Incision, Dual Plane Placement. I am sore all the time, and can't go without a bra. They shift out to the side when lying down and they are bottom heavy. I still have hypersensitivity in the nipples that can be painful at times. I'm tired of hurting all the time. What are my options for revision? and will that stop the soreness and heavy feeling? Tammy

Doctor Answers 9

Breast implant revision after saline implants

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Based on these photos, you have excess tissue in the lower pole of the breast which needs to be addressed with a vertical mastopexy (lift). Sounds like the pocket needs to be adjusted and the implants "held" in a higher position, which will likely require Alloderm or Strattice, which is an acellular dermal matrix (skin). An experienced surgeon in breast surgery can assist you- try Dr. Pat Maxwell in your state.

Best wishes,

Dr. Bruno

Beverly Hills Plastic Surgeon
4.9 out of 5 stars 412 reviews

About Breast Implant Displacement

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During breast implant surgery a #pocket is created carefully to maintain certain folds on the sides and bottom of the breast. Occasionally, the space for the breast implant becomes too large on the #side of the chest or the tissue stretches and the implants fall too much to the side. This is most easily seen when the patient is lying on her back. At times, the implants can move towards the patient’s armpit.

Treatment will generally require closing the space with a procedure called a #capsulorrhaphy. In this case, the capsule is closed off internally much as we do when we are trying to raise the breast fold. The capsule is closed with sutures and at times Acellular Dermis Matrix (#ADM) or other soft tissue substitutes would be used to further support this correction.
However, it is best to consult with your Plastic Surgeon to better determine with an in-person exam.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 116 reviews

Slender patient with breast implant problems

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Your very slender body is more of a set up for the problems you are having than somebody with more tissue coverage and elasticity.  Your HP saline implants have further challenged your elasticity and gravity has won.  As Dr. Johnson said, one option is to decide that your body is not set up for a great implant result and have them out.  This will solve the pain issues most likely.  Otherwise, you might need Strattice placed on both sides to support the implants, go down in size and hope for the best.  This revision would cost thousands because the Strattice is very expensive.

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Revision Breast Surgery

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It looks like you may need revisionary surgery to change the implant pocket so that the implant no longer displaces to the side.   Capsulorrhaphy (internal suture technique) possibly with AlloGraft  will help improve implant placement on your chest wall - but it does come with it's own risks so please make sure that you see a board certified plastic surgeon who has experience with revisionary breast surgery, capsulorrhaphy, allograft use. Unfortunately, more surgery does not equate to reduction of the tenderness/pain.   Obviously, one option is removal of the implants altogether.  

There are many options, see a good surgeon and get some good advice.


Revision requires analysis of the current aesthetic problems

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Tammy, your situation is frustrating but unfortunately not uncommon. The good news is that revision is possible, but a careful analysis is always needed to optimize the probability of success.

As the other surgeons have mentioned, your implants have bottomed-out; they have settled too low. There are multiple factors that contribute to this, including poor elasticity of the soft tissues. The implants are also widely spaced. Correction involves tightening and raising the bottom of the implant pockets (capsulorraphy). Strattice or other so-called acellular dermal matrices (ACDM's) can be used to further support the bottom of the pockets. Textured implants are sometimes helpful in getting the implants to rest at a higher position. I prefer silicone implants if textured implants are needed, because of less visible rippling with silicone. You would also benefit from changing to moderate from high profile implants, to give you a more natural appearance. It is also possible that your implants migrated in the early postoperative period to an entirely subglandular (over the muscle) plane, in which case transfer to the subpectoral plane would be very helpful. It may also be helpful to decrease the size of the implants, depending on your goals.

Generally discomfort will improve if bottoming out is corrected, but there is no guarantee of pain relief with any surgery.

Of course this is all based on a tentative analysis of a few photos, not a thorough history, physical exam, review of your old records, or discussion with you. I hope this helps, feel free to email if you have any other questions. Good luck.

Steven Goldman, MD
Cleveland Plastic Surgeon
5.0 out of 5 stars 168 reviews

Tired of hurting from breast implants

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There are many options to consider when revising breast implants. The troubles you are having however could be solved by simply removing the implants altogether. Your skin is loose and giving and the muscle seems to no longer cover the upper implant. The implant is roaming within the skin envelop and you might be prettier without. As an alternative if you must have implants you should look into an Allergan 410 implant which might better hold the breast shape and resist bottoming.

Best of luck,


Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

You had pseudo ptosis before surgery

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You have  bottoming out of the implants and this would have been expected based on your breast shape and sagging before surgery. You would benefit from down sizing your implants, full breast lift and capsule revision.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.8 out of 5 stars 154 reviews

Strattice internal bra for bottoming out and (maybe) nipple sensitivity

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When the nipples are very sensitive after breast augmentation  and the implants are bottomed out, it can be due to what is called "traction neuropathy" which is basically stretching of the nerves from the pulling down of unsupported implants. That is why wearing a bra makes it feel better. So if the implants can be supported by an internal bra with Strattice or another acellular dermal matrix graft, it could potentially improve both the appearance and the nipple discomfort.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 59 reviews

Augmentation Revision

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From your photos, it appears that your primary problem is "bottoming ouit" of your implants.  This can be fixed but is sometimes difficult.  You need to have a capsulorraphy off the inferior portion of your capsule.  If the tissue here does not hold sutures well, Stratice or some other ACD may be helpful.  Unfortunately there is probably nothing to do to improve your nipple hypersensitivity.

John Whitt, MD (retired)
Louisville Plastic Surgeon

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.