Possible revision surgery after a failed bilateral capsulorrhaphy? What are my options, if any? (Photo)

Good afternoon!I would recommend the Original Internal Bra, my strong permanent internal suturing technique which will correct your lateral displacement- it works and it lasts. This is the most common revision procedure I perform, 5-6 times a week- it works and it lasts and I have the 10-15 year followups that prove it!For the rippling I would consider adding a sheet of Strattice mesh (ADM) to the outer border of your pockets. However, the Strattice mesh by itself will not correct the lateral displacement- only the correct Internal Bra suture repair can do that. In other words, the correct fix is the Internal Bra, and in 20% or so of patients I will add Strattice to help thicken your natural tissues and reduce any chances of rippling.

Previously submitted for your review are suggestions from several really good surgeons. However, I routinely repair this problem with no mesh at all. The internal capsulorhaphy (pocket modification)  uses the patients own tissues. This saves a couple thousand dollars in mesh fees, eliminates the need for a drain, and provides a permanent durable result independent of dissolvable non-permanent mesh. You may keep the implant or change them if you prefer. As far as the cleavage, it is important to 1) ensure that the previous surgeon divided the pectorals muscle adequately and 2) to ensure that the patient doesn't cause this herself with forceful pectorals exercises such as weigh lifting which is the principal cause of bottoming out in this manner.  

It looks like the mesh would have been a good idea. I would do that before fat grafting. The mesh will add support and coverage while fat grafting can only add a little bit of coverage.

Although it is difficult to tell form the photos what is going on, what I do see is the implant rippling laterally.  If you have displacement of your implants to the side then this may be a good time to have placement of an internal bra with such a product called galaflex.  This is a synthetic product that will dissolve after about 18 months.  But during this time it will support your tissues and implants to help your body develop scar tissue to help support them.I would recommend you see a board certified plastic surgeon that has experience in breast revision surgery.Hope that helps.

You have already had 2 augmentations and both have failed.  An alternative to consider 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 can be performed if additional volume is desired.  Best Wishes,Gary Horndeski, M.D.

Dear AlexV1996,
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

Hello Dr. Chao here,
Thank you for your question, Fat grafting should be able to help you with about 50-60% for correction of the rippling. 
Thank you,
James J. Chao, MD, FACS

Hi and thank you for the question. Unfortunately revision surgery following prior revision surgery is pretty common. Your surgeon may have decided not to place the mesh on the day of surgery if he or she found that your capsule as thick enough to hold sutures. Not placing yet another foeign object that is also expensive is not a bad thing. That being said, once a patient fails this approach the next step would be to try something different. Your next revision could involve more aggressive suturing (more total sutures) plus the use of a synthetic mesh or cadaver graft. The medial (part near your sternum/breast bone) aspect of the pocket could also be opened to allow the implants to move closer together along with the suturing and graft placement on the lateral (outside of the breast near your arm) aspect. 
With regards to fat grafting: I don't think it makes any sense for patients to be told to gain weight for fat grafting, unless you plan to live at that new weight long term. When you lose weight fat cells shrink. The fat that you move to your breast will go through this same process if you decide to go back to your preop weight. So you will end up paying for something that works in the short term, then disappears long term. Fat grafting is a great tool for patients who are at their stable weight. But it sometimes takes more than one fat grafting procedure to build up the fat layer that you need to hide implant irregularity/rippling.
Hope this helps. Good luck to you.
Dr West

Based on the photos I would repeat the capsulorraphy but use galaflex or galaform mesh for support. This would bring the breasts in a bit and improve the cleavage. Fat grafting could be added as well 

Thanks for the RS question/inquiry. But even with those nicely posted photos still need just better views (like frontal). Best to seek in person or virtual consultations with private practice boarded PSs not clinics surgeons... I think fat grating might offer a simple answer. I would use micro/milli (macro) fat grating. This could be accomplished undr local anesthesia w or w/o sedation. Fee ranges from $3,000-$6,000.