Is the PS at Fault if my Implants Go to Far Towards/Under Armpits? (photo)

Hello Jodyanne,

To answer your question succinctly the PS is not at fault, because there is no apparent deviation from what would be considered a normal result, at least by the photographs posted.  Additionally, you more than likely signed off on the myriad of complications listed in your preoperative consent forms, including implant dropout/malposition.  Having said that, I am not saying that you should be happy with your result. 

Without actually knowing the conversations you might have had with your PS prior to surgery, you probably got just what you asked for, based on statistics and what I know from personal experience.  Unfortunately, most plastic surgeons do not stress strongly enough how important it is to choose an implant that is appropriately sized for the patient's anatomy.  Additionally, larger implants are less predictable than smaller implants with regards to healing and the potential for complications like yours.  Similarly, higher profile implants are less predictable than lower profile implants.  You are an example of someone with implants that are too big for your chestwall/breast width and have suffered dropout and malposition into your armpits.

To be blunt, you cannot have that much augmentation. It doesn't matter that your friend/sister/cousin got the same size (or bigger) implants and she is doing fine. You won't.  Get used to the idea that the breasts you want in terms of shape and position on your body need to be smaller. 

Revision surgery is more complicated than primary breast augmentation, and should be performed by highly experienced revision breast surgeons.  Certification by the American Board of Plastic Surgery and membership in the American Society for Aesthetic Plastic Surgery are also important as well.

Best of luck!

Hi Jodyanne.

Your plastic surgeon must place your implants where Mother Nature has placed your breasts and nipples.

Your nipples sit far out in the direction of your sides. Therefore your implants sit out to the sides.  If they did not, and sat close together near the center of your chest, then your nipples would be way out on the outsides of your breasts pointing sideways.

I ALWAYS discuss these issues with my patients before surgery. There is no disappointment when people know exactly what to expect.

Finally, you don't tell us what type of implant you have. You probably know that saline implants are heavier than silicone gel devices and do have more of a tendency to fall out to the side over time.

 

Your result is not optimal and you want confirmation that your plastic surgeon did something wrong so he/she will fix the result at a discount. Not knowing what you looked like before surgery or what exactly was done at surgery it is impossible to know what factor(s) contributed to a less than optimal result. Your posted photos show a wide inter-nipple distance with the left nipple further from the midline than the right and a left breast set lower than the right.

I suspect there was some asymmetry before the surgery with a wider than usual internipple distance. These should be addressed by a skin procedure just before or during the placement of breast implants. I do not believe adjustments to the breast implant pockets alone will suffice.

Before undergoing any additional surgery you need to clearly understand what the problem is and what measures can be employed to fix or improve it. Do not proceed without a clear game plan or you will be destined for even more disappointment.

The majority of surgeons will do early revisions after surgery without charging additional surgical fees though you may still have to pay operating room and anesthesia costs.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

without more information , an anser is always difficult..   it appears that your implants are quite large and your breasts may have had some sagging.  the pocket can enlarge with big implants even if it was made correctly.

you will probably need to have the pocket reduced.  maybe smaller implants,  maybe a lift if you want your breast higher

Thank you for the photos. You do not state what size implants you have. Looking at the photos, they are too large for your chest wall, so it is not a surprise that they slide off laterally. In the supine position they go lateral as any woman's large breasts would do.  In the upright positon, they seem a little low, leaving your upper chest flat without a bra. Now it could be malposition or most likely your tissues are not elastic enough to support these large implants and the skin envelope is stretched by the weight. The only "fault" your PS could've committed is if he/she did not discuss with you your anatomic limitations in placement of large volume implants and their consequences.

The implant pocket can be modified to prevent this from happening. The revision is technically referred to as a capsulorrhaphy. Please discuss payment guidelines with your PS as a part of the revision may be covered.

Your breasts will certainly improve in shape over the next 6 months since you are very early in the post operative recovery process. The distance between the breast is determined by several factors.This included the anatomy of your chest and sternum. Since the implant, if placed under the muscle, can only go as close to the middle as the edge of your breast bone this is one limiting factor. If the rib cage is flat the breast will project forward, if it is angled they will project to the side. These are all factors that can be discussed with your plastic surgeon.

Hello,

It sounds and looks like your implant pocket is too big on both sides.  This can be repaired by a "capsullorhapy" or repair of the implant pocket/capsule.

All the best,

Dr Repta

Many times the pockets become larger due to the poor quality of tissues.  It can also happen with the pockets being created too large.

Hard to assign singular blame when we do not have all the facts and when it is obvious that your result could be due to your choice of large breast implants.

Despite everything you read here and other less reputable websites, there is a finite limit on how large an implant can be squeezed into the average woman's chest. We refer to the LAWS of Physics Gravity, Momentum Inertia as laws because they always occur and do not make exceptions. When you critically look at your chest, you have a narrow flat landing on which the implant can sit facing forward without sliding sideways). By picking implants which are significantly wider than this area, the implant base exceeds the flat area and tips sideways. This would happen even if you lived in a gravitation free environment. Add gravity to this situation and in addition to the wider implant base you now have a gravitational pull inferiorly and to the side caused by the implants resulting in the look you do not like. Bottom line - large implants in a petite feminine sloped chest will do it.

Your options - live with it, put up with it until the implants need to be changed or change it surgically. Correcting it surgically is more involved than the original operation and as a result more expensive.