Can someone explain what has happened to create this divot in my breast and if it is fixable? (Photo)

Question

Had augmentation 12 years ago and am planning to get a revision. Each breast looks different than the other, and one has a weird “divot” like the skin is “stuck” to the underlying muscle/ribs. Is there a way to “release“ the skin so it can hang prettier? One side has a more natural “hang” than the other and I’m not sure why they have ended up looking different. I prefer the look of the droopier breast. Plan to increase the size of my implants but what else can be done to improve the appearance (other than a lift, I’m not interested in a lift). Original implants are 265 cc round silicone under the muscle.

Robert M. Lowen, MD · Answer

Dear Nicole,
   The first thing I would do is get an ultrasound of the left breast implant.  This divot could be a fold in the shell of a gel implant.  I have seen them practically folded in two, so they are deformable and can remain so.  Yours have been in a relatively long time.
   If the ultrasound,  or MRI,  if you get one pre-op, shows the implants are intact, your examination in person might show a disruption of the pectoralis muscle origin in that area.  Perhaps the muscle was released too high on the sternum.
  Another factor is the thinness of the soft-tissue coverage over both implants.  It looks like there may be traction wrinkling.  One option to improve this appearance when you get your implants changed, might be a more cohesive implant to better support the shell, such as  Motiva round.
  For treating the defect or deformity directly you could use fat grafting or alloClae.  This would give thicker fatty tissue to fill in the depression and make wrinkling less.

Daniel Barrett, MD · Answer

Dear Nicole805,

I understand your concern. However, without a proper assessment, it would be difficult to determine what is wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

John LoMonaco, MD, FACS · Answer

I think this copmes either from capsualr contracture or the natural process of the implant dropping down  over time and pulling that area of skin where you don't have a lot of tissue.

Options to fix are capsule removal with internal lift and same size implant, or capsule removal with larger implant and a profile desigend to fuill that area in.

A larger implant will "age" your breast sooner witht he added weight.

Best wishes from Texas !

Ned Snyder, IV, MD · Answer

Thank you for submitting your questions/photo!  This contour irregularity can absolutely be fixed.  The plastic surgeon should open the breast capsule in this area and help fill in this space with a slightly larger implant.  I would not recommend a breast lift.  Good luck and thanks again for reaching out!

Safa Sharabi, MD · Answer

Hi Nicole,
Thanks for your question! If you're planning to increase the size of your implants, I would recommend some capsule work in the area of the divot to have the new implant fill in that spot. Alternatively, you could do fat grafting to that area to mask the divot using your own tissue. However, I would not recommend doing both-- it should be one or the other. I'm happy to help however I can!
Sincerely,
Dr. Safa SharabiFemale Board Certified Plastic Surgeon in Santa Monica, CA

Can someone explain what has happened to create this divot in my breast and if it is fixable? (Photo)

Answers (5)

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