Under the muscle implants pushed chest wall out. What are my options? (Photo)

Question

Had a breast augmentation in El Cerrito, California in 2018. The surgeon went 100cc larger than discussed, had me sign off on it the very next morning after surgery while I was still under the influence. Causing tremendous back pain after pregnancy. I have noticed my chest wall looks to be pushed out of place. Possibly only noticing now after volume loss due to pregnancy and breastfeeding. 485 under the muscle, 120lbs 5'4.

Alan Gonzalez, MD, FACS · Answer

Hello @gem08, thank you for your question. Everything has a solution. Depending on what you want, you have different options. If you want an implant removal and go back to your previous size, or if you want a reduction with a smaller prosthesis, it is helpful to see the before pictures, to see the change that you are experiencing. Best wishes. Alan Gonzalez MD, FACS. Best wishes! Alan Gonzalez MD, FACS. American Society of Plastic Surgery Member (ASPS), International Federation for Adipose Therapeutics and Science” Member (IFATS), American Society of Plastic Surgery Member (ASPS), Colombian Society of Plastic Surgery member (SCCP)

Robert M. Wald, Jr., MD · Answer

Breast augmentation simply pushes the existing breast tissue outward. Every woman is asymmetric and 1 breast will not match exactly the opposite breast. Following pregnancy, there will be volume loss and the breasts will change again. What you're seeing may be the underlying muscle or extra breast tissue/fat. I would see a plastic surgeon to discuss this and examine you. Its very difficult to give an exact answer with the photos you have shown.

Gianfranco Frojo, MD · Answer

Sometimes large implants can cause similar problems that women naturally ahve with very large naturally occurring breasts. You might need to consider downsizing implants and having a lift after breastfeeding is complete for 1 year.

Shaher W. Khan, MD · Answer

It is not uncommon for the breast implant to migrate down and out/sideward with time. Some implants fall below the muscle and bottom out, especially with larger implants. Large implants themselves can also cause tremendous amounts of neck and back pain&mdash;not only given their size but the inflammation associated with them. With time, just like skin on the face and the rest of the body start to sag, the breast implants will start to sag even more&mdash;i.e. bottoming out. Unfortunately, explantation is a reasonable option. There is a very small possibility that you could have a ruptured implant. Per guidelines, there is recommendation for an MRI at year three of augmentation and then every two years onward for the life of the implant to assess for silent rupture.

Gary M. Horndeski, MD · Answer

Your breast implants are too large. The technique I recommend is explantation and lift using The Bellesoma Method. The implants are removed, your breast tissue is reshaped creating upper pole fullness, elevated higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained if not injured during your previous surgery. Later, fat transfers or small implants can be placed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Daniel Barrett, MD · Answer

Dear gem08,
I understand your concern. However, without a proper assessment, it would be difficult to determine what went 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

Leland Webb, MD · Answer

With the pictures you provided it does appear as though you have a nice aesthetic result. However, after children and breast-feeding, as you mentioned, the breast can change shape. Often what happens is the implant and breast will descend. I think that what you are seeing in your picture is your natural underlying chest wall that is more prominent due to the lack of volume in the upper pole. Removing implants and doing a lift, or changing the size of implants and doing a lift may be your best option to get some more of that volume up into the upper pole. The difficult thing is that gravity never stops, and this can pull on the implants as well as the breast tissue into the inferior position. You still have some great options ahead of you and it is important to express your goals to your surgeon. Have a conversation about your goals with a board-certified plastic surgeon. We are happy to help in any way we can.

Camille Cash, MD · Answer

Breast implants will not cause your chest wall to be pushed out but things may have shifted a bit from breastfeeding and pregnancy.  You can elect to have your implants removed at any time.  You can also elect to exchange them for smaller ones if you are concerned about the current volume.  I encourage you to visit with an experienced board certified plastic surgeon near you to discuss your concerns and learn more about your options.

Connie Hiers, MD, FACS · Answer

Right now, you need to give yourself time to heal, let the swelling subside and the tissues relax. Once settled, you may be happy. Placing large implants behind the muscle is painful.  Please discuss your concerns with your surgeon.

Alain Polynice, MD · Answer

The first step would be to make sure that there is nothing wrong with the actual implant and the best way to do that is to be assessed by a board certified plastic surgeon and possibly get an MRI. That would be the best way to evaluate the implant and the surrounding tissues. Based on your photos you are very thin and there appears to be a contour deformity above the implant, in the right patient this can sometimes be corrected with fat transfer to the chest to correct the volume deficit.

Under the muscle implants pushed chest wall out. What are my options? (Photo)

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