Pocket repair, BA revision. The sooner, the better? (Photos)

I had BA in May, 3 months ago. Clearly, the right implant is lower ( pic1). When it is best to have a revision? The sooner, the better? Should I wait at least a year? I have an app with my ps in December. Should I see him earlier? Should I change him if he refuses to repair the pocket? Is pocket repair very complicated? Thank you for your help.

Doctor Answers 18

I'm sorry the panel brought up issues that were not concerning to you

but now that its been mentioned, you should mention the lack of an intermammary distance along with your lower implant as issues to be addressed with your revision that you are facing in the future.  Your surgeon should easily appreciate what you are concerned about and if not, you will need a second opinion and you can vent on social media about the facts as you move on.  Most surgeons should desire the best outcome for their patients and should have clear revision policy from which you can choose and this ideally is done 6 months after your initial procedure.

Redding Plastic Surgeon
4.8 out of 5 stars 32 reviews

Asymmetry after breast augmentation...and they are touching too

Ok, sorry to be the rain on your parade here, but you have a few problems. Yes, your right implant is lower than your left implant. The real problem is that you chose implants that are too large, too wide, and they are touching each other on your sternum, which is called "breadloafing". It's possibly from overdissection at the time of surgery, or the implant just needed somewhere to go, because it is wider than your actual breast. It has a super-fake porn look. I'd tell you to wear a supportive underwire bra that separates your breasts a little and you probably need a right inferior capsullorrhapy at 6 months. If you agree with me about the implant touching being "bad" you'll need some additional work to get the width and separation right as well. Come on ladies, please don't choose implants wider than your breasts, it causes all kinds of trouble with bottoming out, rippling, and overdissection.

Lisa Cassileth, MD, FACS
Beverly Hills Plastic Surgeon
4.7 out of 5 stars 12 reviews

Pocket repair, BA revision. The sooner, the better?

Thanks for posting your question and photos Maggie.  I think that it's important to emphasize that what you see is something that I consider to be a big risk of placing an overly large breast implant into a limited breast space to fulfill a patient's request to have a dramatic change in size.  To do so requires lowering the crease and releasing ligaments that can lead in some cases to implant displacement.  I would personally wait for six months to allow completion of the pocket formation and perform capsulorrhaphies and/or subpectoral placement but would not be willing to do the surgery without changing to a moderately smaller implant.  I have had good results without Strattice (but it's a reasonable approach), but have my patients agree to me applying external support tape beneath an underwire bra for 6-8 weeks.Good luck and best wishes, Jon A Perlman MD FACS  Certified, American Board of Plastic Surgery  Extreme Makeover Surgeon ABC TV Best of Los Angeles Award 2015, 2016  Beverly Hills, Ca

Jon A. Perlman, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 29 reviews


Thank you for the photos and YES your complication can be fixed.  So see you r surgeon or other expert in the area and start the process
Dr Corbin

Frederic H. Corbin, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 58 reviews

Implant Malposition

Hello,It is not an emergency, and you are actually still healing. It would be prudent to wait at least a few more months. Your issues are not only dropout of the right but also borderline symmastia. Repair of either is more complex than primary surgery, and if your surgeon isn't a ABPS certified and ASAPS member surgeon who specialize in revision breast surgery, you should visit a few who are for second opinion consultations.Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 78 reviews

Breast revision

i'm sorry that you're experiencing this complication but I would urgent to take care of it as soon as possible. I believe you need to have a revision of the pocket but I would personally using acellular dermal matrix to set the fold and the medial margin of the breast as well. I would urgent process urgent to do this for you soon as possible.

Timing of revision surgery

Hi and thank you for the question. I think the first thing to do is see your plastic surgeon some time toon to go over your concerns. He or she should be able to go over these with you and explain your options to improve the result. The right implant is a bit low. There are a couple of ways this can be fixed including the use of sutures and/or graft material. I think your implants are a bit large for your frame and that your nipple position would look better with smaller, narrower implants. I usually have patients wait six months before performing a revision procedure. Good luck to you. 
Dr West

Justin West, MD
Newport Beach Plastic Surgeon
4.9 out of 5 stars 22 reviews

Revision Discussion-Communication is Paramount

Hi Maggie123, It is important you meet with your surgeon and express your concerns now. Revision surgeries can be done as soon as 3 months post op, but most surgeons will want to wait until after 6 months. But, until that time, there needs to be open lines of communication between you. I agree with some other surgeons that answered that your implants are quite large for your frame. This can be the root of, or contributing to, your issues and I hope that there was considerable discussion and understanding of this possibility before you chose this size implant. Regardless, if you decide to have a revision and go smaller a crease repair would likely be in order to help prevent the same problem from occurring again. Most importantly, meet with your surgeon, formulate a plan of action with a timeline. If you are not satisfied with the level of communication and recommendation made, definitely get a second opinion. But keep in mind, revision/repair surgeries can be very complicated and when the surgeon doing them is not your original surgeon, their compensation request will reflect this. Best of luck to you!

William Aiello, MD
Orange County Plastic Surgeon
4.9 out of 5 stars 30 reviews

Breast augmentation - problem after 3 months

Thank you for asking about your breast augmentation.
  • I am sorry this is happening.
  • Your photo suggests your lower implant is bottoming out.
  • Your implants look very large for your frame - this can be the problem.
  • You should return to see your surgeon to discuss the problem.
  • S/he may want you to wait a little longer, even another 3 months for more swelling to subside.
  • If you were my patient and you had very large implants and early bottoming out, I would recommend repair of the inframammary crease and smaller implants on both sides - or the problem may return.
  • Such surgery is usually done in the operating room.
  • If you feel you do not have a good surgeon, you will need to find a new one.
  • But start by seeing your own surgeon as her/his fees for revision will be lower compared to a new surgeon's.
Always see a Board Certified Plastic Surgeon. Best wishes  - Elizabeth Morgan MD PHD FACS

Pocket repair, BA revision.

I am sorry to hear about/see the problems you are having after breast augmentation surgery. I think your concerns are appropriate; your breast implants do seem to sit quite low on your chest wall, consistent with breast implant displacement ("bottoming out”). Also, consistent with the breast implant positioning problem, the nipple areola complexes seem to be sitting relatively high, because the breast implants have settled too low. 
I think you will benefit from revisionary breast surgery which will likely involve capsulorraphy ( internal suture repair). This procedure serves to reconstruct the lower poles of the breasts and prevent migration of the breast implants too far inferiorly. Associated issues with positioning of nipple/areola complexes should improve with this operation. 
There are no "absolute rules" when it comes to timing for revision surgery;  allowing for six months to one year to pass will allow for "thickening" of the breast implant capsulea and possibly increased strength of the repair.
Make sure that the plastic surgeon who does this procedure for you can demonstrate significant experience with revisionary breast surgery.  I hope this, and the attached link (dedicated to corrective surgery for bottoming out concerns), helps.

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.