Revision for under-dissected pocket or muscle wasn't released enough? (Photos)

I am over 3 months post opt. and still seeing no lower pole or outer pole. (I realize this could be due to pre-surgery aesthetics). However, do I need a revision if the muscle wasn't released enough? Am I being unrealistic that they could/should look better? (hubby thinks not.) I know some will say I should wait longer. But lets be honest at 3 months we can assume they aren't going to change that much more, correct?I am wearing bands/no bras almost constantly, and doing massages my Dr. suggested

Doctor Answers 11

Implant size and chest width #plasticsurgery

I think the issue may be the dimensions of the implant pocket relative to the dimensions of the implant itself. It appears that the implant may have elongated itself along the vertical length of your chest wall, rather than settling into the pocket that was created for it. A revisionary procedure using a smaller implant and some pocket modifications would be a straightforward solution to your issue.

Implants Too High After Augmentation

Thank you for you question and pics: I agree that your implants are high, especially for 3mo post. They may "settle" (the lower pole tissue stretches to accommodate the implant ) but unlikely enough for enough for an implant that size and with your breast footprint. Unfortunately, we don't have a lateral pre-op view, but I suspect it would show a very tight lower pole/IMF (almost 90' angle). For the best result, I would wait 6mo to allow for maximal skin and capsule stabilization, more aggressive release of the muscle and likely downsize implant vs. anatomic implant.

Matthew Becker, MD
Knoxville Plastic Surgeon
5.0 out of 5 stars 28 reviews

Under-dissected Pocket?

Your post-op photos do suggest that the pocket was not appropriately dissected for the implant that was chosen. While your pre-surgery aesthetics show that you have an underdeveloped lower and outer pole, a major reason for having an augmentation is to correct those sorts of deficiencies. Your husband obviously doesn't look at enough before and after photos. Three months is still early, and implants continue to settle for up to six months, but with this degree of malposition and no hint of correction with either a band or massage, it is pretty unlikely that your implant will settle into an aesthetic position. 


One of problems with bands is that they tend to push implants downwards but also inwards, and your implants need to move downwards and outwards. Right now your implants look a little too close together so wearing a band might not be the best thing for you. There is also the possibility that you are developing capsular contracture which will tend to push your implants upwards, but if things have looked like this from the beginning I think that it is unlikely that you have that problem. 


As we have noted your pre-op photos indicate that your lower outer breast was underdeveloped and the distance from your nipple to the fold under the breast was somewhat short. This would be an indication for some lowering of your inframammary fold, but some surgeons are unwilling to do this because of the possibility of developing something called a double bubble. The problem is that if the fold is not cafefully lowered to an appropriate degree then you end up with a situation like this where the implant sits too high and your nipple is rotated downwards.  


I would still probably wait up to six months and continue to do massage to relax the tissues as much as possible. If your implants are still too high at that point then a surgical revision to further release the fascial attachments inferior and lateral to allow your implants to settle into correct position would be indicated. 



Do I Need a Revision after Breast Augmentation? #breastimplants #breastaugmentation

  • Usually by three months post-op your breasts implants have pretty much settled into place.
  • However, it can sometimes take another few months to see your final results. 
  • Without having performed the operation myself, it's difficult to say whether or not the pocket was under-dissected.
  • By looking at your pre-op photo, and looking at the apparent size of your breast implants, it is quite likely that I would have had to lower your infra-mammary fold in order to accommodate these implants. 
  • Without lowering the infra-mammary fold, the implants could end up too high, and would not be centered behind the nipple.
  • You'd have to ask your plastic surgeon to find out what he/she thinks is going on. 
  • Definitely, wait a few more months before considering a revision.  The implants may settle into place more, and you could be happy with the results. 
  • Thanks for sharing!

Revision of Breast Augmentation

This look is seen for two reasons, first is an incomplete release of the lower muscle because  the dual plane technique wasn't done, second, the implant dimensions are too big for your chest. But without access to the operative report and an exam of you, there is no way to know if this is correct. Any further changes in your contour after three months will be quite minor. 

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 24 reviews

Breast Augmentation Revision?

At three months post-op the pocket has usually stabilized, and further descent of the implants is unlikely. When the implants are positioned too high, the nipple-areola position is driven lower. With a revision of the implant pocket called a capsulotomy, the implants can be repositioned for a more optimal shape. I would discuss the timing of this procedure with your plastic surgeon.

Michael F. Bohley, MD
Portland Plastic Surgeon
4.9 out of 5 stars 15 reviews

Revision for under-dissected pocket or muscle wasn't released enough?

Although I do understand your concerns,  I am one of those plastic surgeons who would advise you to continue to be patient. I have seen breast implants continue to "settle" for the first six months after surgery and longer. 


 Of course, your plastic surgeon knowing exactly how/where the breast implants pockets were dissected will be your best resource when it comes to more specific  advise and/or predictions.


 If, in the longer term, breast implants are not where you wish them to be, capsulotomy (release of the lower breast pole tissues) will be necessary to achieve an outcome that you will be happier with.


Best wishes.

Revision

I can see your concern from your photographs. The right breast started out with a higher crease and a smaller base width. It should take more time, all things being equal, for the right breast to stretch out that smaller skin envelope compared to the left. If, on dynamic flexion of the pectoralis, there is more muscle action on the right than on the opposite side, I believe that at three months, plenty of time has passed and without added release of this muscle, the implant will probably not drop any further. Your plastic surgeon will be your best resource to evaluate the situation. Best of luck.

Marc J. Salzman, MD, FACS
Louisville Plastic Surgeon
4.7 out of 5 stars 44 reviews

Implants haven't settled after 3 months

Thank you for your question about your breast implants.

You are correct - your implants haven't settled. This should not be your final result. A revision can be done now but the tissues will be more swollen and it may be harder to get a good release. I always recommend that patients wait 6 months if they can. I have not found the bands helpful - but going braless does help gravity pull the implants down. Ask your surgeons if you can try this.

Best wishes Elizabeth Morgan MD PHD FACS

Malpositioned and large breast implants

Although a physical exam and a complete review of your history is needed, your implants are high, and too large for your dimension. They are most likely the wrong profile as well. Your initial presentation made you prone to this as you lack some lower and lateral (outside) pole tissue. I strongly suggest a revision and revisiting using smaller dimensional implants than the one that you have. A simple release of these will not likely correct the issue. Good luck.

Sepehr Egrari, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 48 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.