What is Wrong with my Breast Implants? How Can They Be Fixed? (photo)

Looking at your pre-operative photographs, you obviously needed a mastopexy at your first procedure combined with possible implants if you wanted to be larger.  Now you have implants high on your chest and your breast tissue is hanging too low.  If you want to keep the size you have, you can maintain the same implants but you will need a mastopexy.  This can be done through a circumareolar approach and elevate your breast tissue so it lies on top of your breast implants.  Once you align the nipple, breast tissue and implant in the same horizontal plane, projection will be much better and you will look more natural.  I often use this technique to correct your type of problem with very nice results. Your other alternative is to remove your implants and do a mastopexy.  This would result in significant size lost and you would be back at your 34 B.

Best of Luck,

Gary Horndeski, M.D.

Your pictures are very informative.  I would first ask how you feel about your size.  A change in implant size needs to be addressed if you desire more or less volume

.  Also since you are 21 silicone is not an option.  Next the nipple is too low in relation to the breast mound.  Most likely a lift will be needed.  On the last picture (left lateral view) it is evident you have a double bubble.  This can be repaired at the time of surgery by re-establishing your previous inframammary fold.  Since you are going to need a lift anyway the nipple can be easily located in reference to this new (or old) fold.  Lastly if the capsule around the implant is tight or thick, it will need to be released by capsulotomy, capsulectomy is not necessary it saline implant is currently present.

As always you need to be aware of possibility of changes which may occur as the result of weight gain or loss, pregnancy, etc.

It looks like you may need some type of revision based upon your physical exam.  The breast is being squeezed in a funny way as the muscle flexes.

Your pictures indicted implant and breast tissue separation and sagging of the breast tissue off the implant. This can be due to the improper implant placement,capsular contracture or combination. You have mild ptosis based on your pictures which may be misleading due to the camera angle. Please send front  pictures  without holding the camera.

Thank you for the question and pictures.

I think your description is quite accurate  and matches the pictures you have provided. Revisionary surgery is definitely indicated. Although difficult to give precise advice without direct examination,  I think some combination of capsulotomy/capsulectomy  will be necessary to release the pectoralis muscle “grip” on the breast implants.

Once this is done, some skin “tailoring” ( probable breast lifting) will also be helpful to allow breast tissue and skin to sit appropriately over the breast implants.  This combination procedure may help the situation where the breast tissue sits as a separate unit off the breast implant.

I would suggest in person consultation with well experienced board-certified plastic surgeons who can demonstrate significant experience with revision breast surgery.

Best wishes for a much improved outcome.

I strongly disagree with some of the responses so far. This problem was caused by the original surgery or how it healed although in three years it's possible that there has been some degree of capsule contracture or sag (ptosis) of the breast over the implant. 

The original implant looks too wide to fit in behind the width of the released pocket behind the breast properly so it moved up where there is more space for it. The lower pole of the breast was inadequately released so that a proper sized implant could fit in it and be properly positioned behind the nipple-areola. Apparently the pectoralis muscle was also inadequately released such that it pulls on the lower breast or capsule and causes the double-bubble effect. 

The nipple-areola is low but not too low relative to the inframammary crease and a proper sized implant should be able to fit into the expanded lower pole of the breast and not need a lift (mastopexy). It is possible to leave the implant where it is and lift the breast up to it (although the pectoralis and double-bubble problem would still be there) but the simpler solution is to lower the implant and properly release the pectoralis muscle and tissues of the lower pole. It might be possible to use the existing implant if temporarily removed via an inframammary crease incision and then replaced, but consideration should be give to a proper sized implant that fits the breast and meets the patient's expectations related to forward projection/size. 

The photo you provided from the front is not a straight on frontal view but rather a photo taken from above which makes the nipples appear lower than they actually are.It appears you would however benifit from a revision. I would suggest a straight on view from the front and a side view from each side.