This is my 3rd Revision. Second Round of Strattice? Pocket Revision?

These are my breasts after a revision for a malpositioned implant on my left side. The surgeon added strattice to improve the skin thickness. I went down in size of implant also. There is now rippling and implant looks to me like it is bottoming out? Will another round of Strattice improve things? I am concerned because many of you think I should not mess with it anymore, yet as you can see it is very unattractive. One surgeon suggested larger implants with pocket revision?

Doctor Answers 6

Your pectoralis muscle is detached and pulling your left breast to the side

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The solution is not to use strattice or alloderm. You need pocket revision and I would not go with bigger implants since you have very thin tissue. I would also do fat grafting to increase the thickness and  use silicone gel implants. In some cases if patient does not want to deal with implants anymore, I have removed the implants and done fat grafting. please check my web site.

New Orleans Plastic Surgeon
4.7 out of 5 stars 152 reviews

Another round of revision may yield limited results.

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One of the misconceptions about Strattice is that simply placing it eliminates rippling and malposition. It truly needs a "hand-in-glove" application. The implant needs to fill out the pocket precisely or rippling recurs. Unless a pocket tightening procedure was performed, a smaller implant will likely lead to more rippling. Also, in the photos, the medial and upper poles are rippling as well. In some difficult cases, Strattice in the upper pole is necessary to camouflage this as well. Fat grafting is also an option. Revision surgeries can often correct issues, but there seems to be a law of diminishing returns, particularly in breast surgery. Although it is difficult to hear, there does come a point when further surgery is no longer the answer.

David Bogue, MD
Boca Raton Plastic Surgeon
5.0 out of 5 stars 26 reviews

Third revision, second with Strattice

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Without a full examination but going by your history and these photos, it would appear improvements might be possible with a combination of changing size of implant, modifying the pocket, possibly utilizing additional Strattice and definitely utilizing fat grafting.  I strongly recommend you seek advise and help from a plastic surgeon certified by the American Board of Plastic Surgery who additionally has a vast experience and reputation with successful revisional breast implant surgeries. 

Revision of breast augmentation

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There may be a role for additional dermal matrix to thicken the pocket where the rippling is visible. A very slightly larger implant may also help. Is your pocket above or below the muscle? If it is not below the muscle, conversion to below the muscle may help in the cleavage area. There is something about the lower curvature about your breasts in some of the photos that looks like a slight mismatch between the implant position and your natural breast tissue; it is possible that a small lift might need to be done to move your breast tissue up very slightly, in combination with a pocket manipulation/Strattice to improve the coverage over the rippling.

My office is local to you and I would be happy to evaluate you, if you are so inclined.

I will caution that sometimes, as one of the authors above has stated, chasing "perfection" may yield new problems that might be less satisfactory than what you start with. Only face-to-face examination with a board-certified plastic surgeon can adequately allow for a fair assessment.

Good luck in your decision process.


Tim Sayed, MD, MBA, FACS
Newport Beach Plastic Surgeon
5.0 out of 5 stars 22 reviews

Revisionary Breast Surgery

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Yes, it looks like you may need revisionary surgery with possibly larger implants, further pocket work and possibly the use of Alloderm for the rippling issues you are experiencing.  I have helped many patients in similar situations.  Revisionary surgery is tricky... make sure the surgeon you choose has experience with this type of surgery. Ask to see before and after photos of similar situations and even speak to other patients.

Are you "as good as it gets?"

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I can see from your photos that you are exceptionally thin and this will always make implant surgery more complicated.  One thing to consider is that there comes a time when it is "as good as it gets" even if it is not perfect.  Too often, patients try to have repeated revisions trying to reach a result that their body just won't allow.  You might be there.

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.