Weirdly square upper pole, etc.? 2 months post. Natrelle anat. partial unders. SuperTight surg.bra 1st week. No bandeau (Photo)

Noticed imm. on first morn. post-op my left breast had slipped in a strange angle and was protruding from ribcage. Got new surg.bra+sown-in bandeau. Wore that til my check-up at 4 wks post-op. Swell. nearly gone, "Frankenboob-part" intact. Implant can be felt very well+ hard. Frontview square thru my skin (I have own tissue also,not skinny). Surg. adv.@ 4-week: cast All bras aside-> own tissues drop, Impl not. I massage, take Montelucasti, no bra but xtra bandeau 24h. Sleep semi-upright.

Doctor Answers 8

Upper pole problem

Without knowing more, it is impossible to say. As a wild guess, you may have anatomical implants of the 'tall' variety, which may come a bit too high on your chest and become visible.


London Plastic Surgeon
5.0 out of 5 stars 17 reviews

Misshapen and Malpositioned Breast Implant

I'm sorry to see that you're having this problem. I would be able to make better comments if I was able to see your preoperative photographs, and several different views of this current problem with your left breast. Knowing a few of your preoperative measurements, and what type of implant was placed would also be helpful.

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.

Kenneth Dembny, II, MD
Milwaukee Plastic Surgeon
4.9 out of 5 stars 34 reviews

BBA

It's hard to tell what's going on from the photo. You should see your surgeon in person. All the best. 

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Asif Pirani, MD, FRCS(C)
Toronto Plastic Surgeon
5.0 out of 5 stars 35 reviews

Anatomical implant visible

It looks like the implant is too tall for your chest and sticks out. Unlike round implants the anatomical ones will pretty much stay where they are. You may need a shorter implant. Unlikely that time will improve this shape. You need to discuss it with your surgeon.

Azita Madjidi, MD
Houston Plastic Surgeon
5.0 out of 5 stars 5 reviews

Upper pole problems in your left breast.

I agree with the 4 previous notes.  Without seeing your preop and better postoperative pictures and reviewing your operative notes it is difficult to be definitive about what has happened.  I had one similar patient who looked great on the operating room table and then had the upper aspect of a implant look like your breast at week #1 and somehow it corrected by week #2.  Many of my patients have found the style 410 implants too stiff even in reconstructive situations and I have discontinued the use of a that style of implant for most patients.  I would guess that you have full height implants that are tipped over at the top on the left side.  It sounds as though you're doing everything possible nonoperatively and I would easily give this 6 months prior to reoperating. I wish  you the best of luck with this problem.

David Janssen, MD, FACS
Oshkosh Plastic Surgeon
4.9 out of 5 stars 14 reviews

Upper breast pole problem

It sounds like you are doing all of the right postoperative measures.  I would wait another few months as your results will continue to change.  The anatomic implants have a different postoperative course than the smooth round implants.  I would discuss this with your surgeon and hopefully your enjoy your results in a few months.  Good luck!

Andrew Freel, MD
Baton Rouge Plastic Surgeon
4.9 out of 5 stars 12 reviews

Square

Honestly, there is not enough information to begin to know, especially without all views pre & post and knowing EXACTLY how the surgery was done. One trade off with the contour profile implants is that if they are not exactly aligned vertically, the "shape" of the implant does not change, only the position and this "tilt" can be noticeable. You ARE still going to have change with more time so whether or not it will correct, it WILL change.

Robert H. Hunsaker, MD
Miami Plastic Surgeon
4.4 out of 5 stars 72 reviews

Square upper pole

 It's hard to evaluate a single postop picture without seeing you face on and seeing what you look like preoperatively. It sounds like you've taken all the precautions into helping your breast implant to descend into the bottom of the pocket created for it. Natrelle 410 implants are unique in that they are aggressively textured and sometimes will move less after they are placed  than a similarly placed round smooth implant. I would follow up with your plastic surgeon and asked them what else can be done to alleviate this problem. At two months postoperatively there's still more stretching that can happen. Good luck with your continued recovery. 

Marc J. Salzman, MD, FACS
Louisville Plastic Surgeon
4.7 out of 5 stars 46 reviews

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.