The right pocket repair or a bigger right implant? How to make the right look fine (Photos)

I moved anantomiacals and rotated the right one, explanted sure that my doctor repaired the right pocket, which didn't happen. My right breast revision result shows that the implant seems to have landed in the old pocket, which caused shape difference. Is the right pocket possible to fix?When I push the right rightwards the assymetry evens out ( pict 4). Can going bigger on the right help?

Doctor Answers 5

Breast Implant Revision

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Thank you for your photos and questions. The photos suggest that you have pretty large implants with some bottoming out and expansion of the right pocket across the center of the chest. My impression is that larger implants are not the solution and would make your condition worse. These issues could be addressed with pocket revisions but an in-person exam is necessary to confirm these impressions and come up with the best plan suited to your problem. Breast implant revisions can be very challenging and I hope you eventually get the result you want!

Rotated breast implants

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If the implants are rotated, revising the pocket called a capsulloraphy is often necessary. I don't know where you are in your post op course but if you can press on the implant and move it you might be able to move it to the right location with some compression if early in your post op course. A small band over the area will help. Otherwise, you will require surgery.

Susan Kaweski, MD
San Diego Plastic Surgeon

The right pocket repair or a bigger right implant?

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Dear Maggie123

From the photos, I agree that your tight breast implant infra-mammary fold needs to be reconstructed. Going larger will likely lead to other problems such as synmastia. I would suggest remaining same size and just repairing the pockets to improve the look and symmetry of your breasts.
Look for an experienced and well trained plastic surgeon certified by the American Board of Plastic Surgery. See more than one consult and make a well informed decision.

Pocket Revision

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Thank you for the photos and question and YES the pocket does need to be revised and can be in the hands of an expert.  So go on some complimentary consultations, look at photos of similar patients and find your surgeon.

Dr. Corbin

Bottomed out implant

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 It appears to me that the right implant pocket is elongated causing the right breast to bottom out. When a breast implant migrates below the original placement location with the bottom of the implant just above the infra-mammary crease, we call this “bottoming out.” There are several causes of this downward migration of the breast implant. Usually, some attempt had been made to lower the crease to accommodate a breast implant whose base diameter is larger than would otherwise fit in the natural breast. In doing so, the anatomic attachment of the skin of the breast to the chest wall can be obliterated. There is then nothing to hold the implant up. With the weight of the implant, and constant gravity, maybe lack of support by lack of wearing a bra continuously, the implant can settle downward. One of the earliest symptoms, I see in patients seeking revision,has been the feeling that the breast has to be constantly adjusted or just feels heavy. We look for the incision line, which was previously placed at the crease, to have migrated upward onto the breast. When we see this early on in the postoperative phase, it will never get better with time and will require a secondary repair. While some plastic surgeons may rely on suturing techniques only, I have found that unless we un-weight the implant by making it smaller or strengthen the tissues below by making them less stretchy, that the same implant, with just sutures placed on the bottom of the pocket, will, over time, recur it's bottomed out position. I have used part of the capsule as well as the lining of the deep muscles and tissues over the ribs in the capsule beneath the breast implants to rotate upward to hold the breast implant in a higher position and therefore obliterating the extra space that has been created between the correct infra-mammary crease and the one created by the downward displacement of the implant. I call this a three flap technique, as the skin, the capsule and fascia (lining of muscles), as well as a dermal flap all contribute to creating a hammock like support of the lower portion of the pocket. When these tissues are insufficient to hold the implant up, or a previous attempt has been made with sutures, I will oftentimes rely on the addition of another type of tissue called an acellular dermal matrix of which my preference is Strattice. This Strattice ,or pigskin, does not stretch and can be sewn in to the bottom of the new location of the crease to support it just like a hammock would. Although this is costly, I consider this an insurance policy against having to redo this again. I would recommend that you try and find a plastic surgeon with experience in revisionary cosmetic breast surgery. Good luck.

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