3 Revisions in a year - Mal positioned/ animation deformity. What are my options for fixing this? (Photo)

The muscle is way over released. The best option would be to perform extensive pocket revisionary work, adding internal support (such as Galaflex), and potentially doing a vertical mastopexy ("lollipop scar lift") to more properly position the nipple-areola complex. This is a complex problem that requires a very well trained plastic surgeon with extensive experience in this type of revisionary surgery to tackle.

You have very severe asymmetry and it is very difficult to correct asymmetry. One thing you may consider is taking out the implant and at that time undergo repair of the muscle. It appears to be cut and retracted. Then after 3-6 months, consider re-implanting. You will also need the nipple-areola complex repositioned more medially and inferiorly.

Best Wishes,

Gary Horndeski, M.D.

Based on only one post photo decision or recommendation cannot be made with just one posted photo best to do a virtual consultation so more detailed examination can be observed and give better opinions. My first assumption is most likely should’ve changed the location of the implants from under the muscle to dual plane above the muscle combination, but now that’s too late Cause it worsen the results. Best to consider above muscle dual plane positioning, but again most virtual console. Expect fees to range from $8000-$15,000 because of a difficult case and impossible use of internal bra mesh. Again best of virtual consult with.

Your left breast has bottomed out pretty badly.
The line across the lower half of your breast, most likely represents where the pectoralis muscle was transected.
Personally, I try to leave as much of the pectoralis muscle intact as possible.
The muscle needs to be cut to some degree to insert the implant and allow the implant to sit low enough.
If too much of the muscle is cut and the IMF (infra mammary fold) is violated the implant will drop. Based on this information, I suggest you consider a different plastic surgeon.
When consulting for revision surgery, bring pictures of yourself to use as reference.
You should come prepared with a complete set of before and after pictures for each of your previous procedures.
You should also get copies of your operative reports.
These are all part of your medical record that you can request from your current provider.
During consultations as each provider to open up their portfolio and show you their entire collection of before and after pictures of the previous patients who had similar situations.
You may want to ask the surgeon with the most common indication of for revision surgery is, what their revision rate is and what their revision policy is.
Ask them specifically how many times they’ve corrected bottomed out implants.
Asked them what their success rate has been.
Ask them to show you before and after pictures of previous cases.
Look for a senior plastic surgeon who has extensive breast surgery experience.
If you don’t know who to go to consider finding out who does most of the breast cancer reconstruction in your area.
Surgeons who do a lot of breast cancer reconstruction are typically good at difficult breast surgeries.
The double bubble look may be difficult to correct if the muscle was transected too high.
Converting to a sub, glandular implant position might correct this, but will not correct the implant being bottomed out.
Securing the implant in a higher position is usually done with internal permanent sutures with or without mesh or cadaver dermal products like Alloderm.
To find the best provider for your needs, I suggest having multiple consultations.
One of the biggest mistakes I see patients make is having only one consultation and then scheduling surgery.
By having only one consultation patients, eliminate the ability to choose a better provider.
Interview several providers before you choose one.
Insurance is not going to pay for your procedure unless you have a documented capsular contraction in which case capsule surgery is covered.
It’s only covered if it’s symptomatic though.
Insurance did not going to pay for correcting the position of your implant.
When in doubt, slow down and schedule more consultations.
Most patients do not have a lot of experience consulting with plastic surgeons. And.
By having several consultations, you’ll get better at the process and will be in a better position to vet providers.
Good luck,
Mats Hagstrom MD