Weirdly square upper pole, etc.? 2 months post. Natrelle anat. partial unders. SuperTight surg.bra 1st week. No bandeau (Photo)
Doctor Answers 8
Upper pole problem
Misshapen and Malpositioned Breast Implant
Meticulous pocket dissection is important when utilizing anatomic implants. This helps prevent implant malposition from occurring post-operatively. Assuming that the surgeon would not let a patient leave the operating table with this type of breast shape, this obviously occurred in the very early post-operative period after you were discharged home. It is possible that the implant shifted within a pocket that was dissected too large. However, with the amount of upper pole fullness that is present, I think it is unlikely that the breast implant would rotate or flip 180° in that short period of time. Anything less would place the abnormality lower on the breast. More likely, it seems that the implant has been forced upward, perhaps by the pectoralis muscle. A relatively forceful and/or persistent muscle contraction could cause the implant to slide upward, and essentially come to rest in almost a complete subpectoral position. This would cause folding or buckling of the upper portion of the implant, and produce the shape you currently have. Once forced into this position, because the implant has a textured surface, there is likely too much friction for the implant to just slide back to its original position. Therefore, the implant became stuck in this position. This would explain why the tissue swelling has subsided, but the implant has not moved.
A full height anatomic implant would be more likely to produce this complication as well. Especially if the height of the implant was a bit over-sized for your height. Forcing a full height implant into a submuscular pocket of a woman who's measurements would otherwise indicate that a medium height implant was more appropriate, could potentially be a precursor to this problem.
Smooth round breast implants (saline or silicone) usually demonstrate some degree of exaggerated upper pole fullness post-operatively. The round implants settle into position overtime. This may involve a small amount of implant descent within the pocket, but otherwise it primarily relates to a volume redistribution of the gel. Anatomically shaped textured surface silicone gel breast implants do not demonstrate the same amount of excessive upper pole fullness post-operatively, and do not go through the same settling process. The highly cohesive form stable gel in an anatomic implant, is not forced into the upper pole with these implants as much as it is in a saline or moderately cohesive round implant. Therefore, there is very little gel redistribution during the recovery process. And, the implant does not settle down within the pocket because the implant is held in place by the textured shell.
At four weeks post-operatively, the textured shell of your implant is integrated into the capsule around it. No degree of massage or compression band use will cause/force this implant to drop or change shape at this point. You will require surgical revision for correction.
Just to offer an alternative comment to a statement made by another physician. My patients have not found Natrelle 410 implants to be too firm or stiff. In fact, I question all of them, and they are very happy with the consistency of this gel device. The silicone gel within these implants is slightly softer at body temperature, then compared to room temperature. However, if the gel within the 410 is considered to firm for one's liking, the gel filling of the Mentor memory shape or the Sientra anatomic implants is a bit less cohesive and may provide an alternative option for patients.
It is unfortunate that you have experienced this problem. These anatomic implants are really nice and produce great natural-looking results.
Speak with your surgeon about this. If necessary seek a second opinion. Best wishes.
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