Considering implant revision but fear worse result - is it worth it? (Photos)

Dear Jubilant488752,

breast revision surgery is the most difficult plastic surgery procedure performed. Botched breast surgery alters normal tissue planes and laxity, the ability of breasts to heal properly, and leaves scar tissue that dramatically affects the level of difficulty of the corrective surgery.
Many patients come in to correct poor outcomes from their initial surgeries. The most common problems are due to implant malposition, bottoming out of the implant, poor scarring, and incorrect implant size.
While the type of revision required will depend on the result of the previous surgery and the desired result of the patient, some revisions involve extensive pocket repair that may or may not need specialized external bras.
If you are considering breast surgery revision, you should speak with a board certified plastic surgeon and have yourself properly assessed. Only after a thorough examination you will get more information and recommendations. Also, you have to make sure that your surgeon understands your breast augmentation goals.


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

From your description and photos, cannot decide for you what to do but will state my own observations from thousands of breast augmentation and revision augmentation procedures. First, you are lean and if implant submuscular, the anatomy of your pectoralis major myotomy and pocket may create an angularity or localized flatness along wit expected animation. Second, your result is overall spectacular so your concern about potential aesthetic deterioration by another procedure is justified. Third, if you don't understand exactly the surgical plan, clarify the plan with your surgeon until you do understand and agree with the plan and the back-up plan if things don't work out. Implants are imperfect mechanical devices, and achieving perfection with their use can be an elusive proposition. Your current result may not be easily surpassed. Fat transfer (if you have any to spare on your body) may be an alternative if that area is really bugging you.

A square or boxy contour on one side almost always comes from how the pocket and capsule are shaping the implant rather than the implant size itself. Common drivers include a tight lower pole or a high fold, a stiff lateral capsule that flattens the curve, an early capsular contracture or a mismatch between implant base and breast footprint.
What a corrective plan often includes• Pocket reshaping with precise capsulotomies or limited capsulectomy to round the inferolateral contour• Fold adjustment if the inframammary fold sits too high on the boxy side• Parenchymal releases or radial scoring when the lower pole tissue is constricted• Dual plane refinements and selective muscle release only where animation or tightness is distorting shape• Implant change only if base width or gel profile does not match the breast footprint
What to clarify before saying yes• Which finding is believed to cause the boxy look on the left side• Whether the plan is fold lowering and targeted capsulotomy versus simply “making the pocket bigger”• How lateral control will be secured to avoid drift after surgery capsulorrhaphy, internal sutures or mesh if indicated• Whether the capsule feels tight suggesting an early contracture and if anterior capsulectomy is planned• If sizers will be used intraoperatively to confirm symmetry before closure
Is this straightforward• Mild pocket distortion can be a relatively limited revision• Results depend on accurate diagnosis of the deforming force and disciplined pocket control• Usual risks include asymmetry, malposition, seroma, infection, sensory change and need for further revision
How to decide with more confidence• Ask for a focused exam with measurements nipple to fold distance, fold height symmetry, soft tissue pinch in the lower pole and a capsular assessment• Review standardized photos upright and supine so the plan targets the real driver of the shape
The details here are not enough for a precise plan. If a more specific opinion would help, standardized photos and your operative notes can be reviewed through a short complimentary conversation with a coordinator so the technical questions above are addressed before any medical evaluation.
Wishing you calm and clarity as you choose the safest path to a rounder, more balanced result.Güray Yeşiladalı, MD

You should post proper before and after pictures.
If you don’t have before, and after pictures, then ask your surgeon to forward the pictures they took.
You should have a set of proper before and after pictures to use.
I can’t really see what the issue is from the pictures you’ve included.
Are you using a mirror to take a picture?
Doing so reverses the image.
If you’re going to take your own pictures, then use the timer on your camera or have someone else take the picture for you.
Your surgeon should be able to clearly explain what the problem is and exactly what you’re going to do during the revision.
The first step in any plastic surgery procedure is always to have a clear understanding of what the problem is.
You can’t apply a proper solution until you understand the problem.
I can’t tell you if you should move forward with the procedure or with your current provider.
You’ll have to make the decision based on your own understanding, knowledge and instinct.
Best,
Mats Hagstrom MD