What is wrong with my breast? Breasts too high 6 months after BA (Photo)

Question

I had a BA start of December 2022, got Motiva 625cc implants placed semi-under the muscle . i have attached before, day after surgery and now (5 1/2 months post op). at 3 months my surgeon told me we need a revision to simply bring them down but i am concerned if this will fix the pec look. I have some small pains sometimes in my left breast but they aren't painful besides that. If you could help me with your advice, opinion and also things i should confirm before surgery

Albert Ko, MD · Answer

Hi there, thanks for your question. Your implant is not positioned properly in your breast pocket, and also may be too large. I would reccomend that you ask your surgeon to reposition your implants and possibly go smaller.

Ted Eisenberg, DO, FACOS, FAACS · Answer

Always best to check with your surgeon. If they can't be reached check with a local surgeon. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

Brian K. Reedy, MD · Answer

Thanks for your question! My first thought is that implant is far too big for your frame and breast. You will likely need to go smaller and some capsule work should be done to allow the implant to settle into the breast. I might suggest seeking a second opinion as well. Good luck!

Zoran Potparic, MD · Answer

First thing that you will have to sacrifise for better symmetry is volume of implants; you have to go much smaller if you want natural looking breasts. There is just not enough space on your chest wall and your skin envelope is too tight for such a large implants. Your small frame can tolerate maximum of 350-400 ml. for breasts and chest to look normal, like it or not. Hope this helps. Good luck.

Daniel Barrett, MD · Answer

Dear Pioneering35788,
I understand your concern. However, without a proper assessment, it would be difficult to determine what went wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

J. Alex Kelamis, MD · Answer

Hello Pioneering35788:
I am sorry you are experiencing unexpected results after your breast augmentation procedure. Ultimately, this can be fixed but will require surgery. I noticed in the photos the left breast appears larger than the right. It may simply appear larger than the right due to the malposition. I would recommend a detailed exam by your surgeon to rule out any fluid collection. If a fluid collection cannot be ruled out on exam, I would recommend an ultrasound. It is unlikely for you to have a collection, but it’s important to know if one is present. Regarding the left breast implant position, you have good pec major muscle development; this is a good thing. There are really two types of “partial submuscular pockets”. One is called a dual plane, where the pec major is released just above the level of the lower breast crease. This is by far the most common type of partial submuscular pocket used. One problem with a dual plane pocket is, sometimes, the width of the released muscle can be too narrow, and the implant is not able to fully deliver into the lower breast. This is likely the issue with your left breast. If it hasn’t settled after five or six months, it isn’t going to without surgery. The other issues with dual plane pockets are animation deformity (the muscle contracts and causes the entire breast to move) as well as a boxy breast shape in individuals with significant pec muscle development. I haven’t examined you, and I cannot make any claims with certainty. However, if you enjoy lifting heavy weights for muscle bulk, I would recommend transitioning to a subglandular pocket. This would place the implant completely on top of the muscle. The other option is to use another partial submuscular pocket called a split pec pocket. In this type of pocket. The pec major is split from where it attached at the bottom part of the sternum, straight to the crease at the front of the arm pit. You will not get animation deformity with this pocket. Only the top third and inside quadrant of the implant are covered by muscle (so it greatly reduces rippling, just like a dual plane). One other benefit to this pocket is the implant has downward pressure on it, from the top part of the pec muscle, helping it to fill in the lower breast. You typically achieve maximum implant projection with this pocket (although it is barely noticeable from a subglandular pocket, it can be significantly more compared with a dual plane).Typically, a dual plane pocket can decrease projection of a breast in people with larger pec muscles. I believe you would do much better with a split pec pocket, or subglandular. Converting from a dual plane to either is very straight forward and can easily be done. At the very least, the released portion of the left pec muscle needs to be released slightly more, and the implant needs to be well below that released edge of the pec muscle before you leave the operating room. If you are pleased with the appearance of the right breast, it is totally reasonable to keep the same pocket, and just have your surgeon release the left side a bit more. I would ask your surgeon to have an extra implant, identical to the one currently in the left breast, in case the implant is torn or punctured during the surgery. As far as other specific questions, you need to know exactly what the surgeon’s plan is, you need to understand why this is the recommended plan, it needs to make sense to you, and you need to feel comfortable with the plan. I wish you the best. You should have no trouble achieving the results you desire.

Camille Cash, MD · Answer

From the photos your implants are too large for the space.  A surgical revision is needed to help them settle into the pocket.  You may want to consider smaller implants to be exchanged at that time as well.

Douglas Taranow, DO, FACOS · Answer

You are correct.  Your breast implants are too high and require a capsulectomy (breast revision) to lower them properly into the pockets.

Connie Hiers, MD, FACS · Answer

Your implants are too large for your frame and cannot drop. Your surgeon can lower them down to fit better. However, you would do better with smaller implants long term.

Douglas J. Raskin, MD (retired) · Answer

Greetings,
The implants are high and large as you noted.  You would benefit from a re-examination and consultation with your original surgeon.  You might seek second opinion(s), for piece of mind, before you embark on further surgery.  Photos alone do not provide a reliable direction for your care.
Best Regards,

What is wrong with my breast? Breasts too high 6 months after BA (Photo)

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