Implant Revision for Animation Deformity and "Bottoming Out": Age 50, 5' 08', 155#, Athletic, 22% BF. Dallas, TX

I decided to replace 350cc anatomical style 410 implants that had been placed in partial retro pectoral pockets in 2009. The 410's had bottomed out, I had animation deformity and skin creases from flexion. I wanted to correct these issues. The revision was done with new 345cc round cohesive gel implants, neo subpectoral pocket repairs, gala flex, and fat graph by a talented surgeon.

Backstory: not too long after the first augmentation in 2009, the 410 implants dropped to where they are seen in the before photos. The animation deformity, which happens while flexing my chest muscles, began by 1 year post op. I expressed concerns and ultimately asked for a revision from the 1st surgeon. He told me he didn't do revision but I could go find someone else. He also told me if I found another surgeon that I would be removed from the study for the new (at the time) anatomical 410 implants. This meant I'd lose the longer follow up period, testing, and reimbursement for being part of the study. In a less than polite way, he reminded me I still had an improvement over my natural, unaltered appearance. I ended up not seeking a revision at the time. I also never got to meet with him again at any of the later follow ups and was passed off to his staff from that point on.

The study ended and as time went on, I starting thinking more about revision. Fast forward 7 years to now: I turned 50 recently and decided to take care of myself this year. I've been intensively care-giving over the last 2 years for an elderly parent with alzheimers that broke a hip. I went on many consults; half said I should go over the muscle to fix the deformity, some suggested other sub muscle fixes. I know my family doesn't have a good track record with skin elasticity and didn't think sub-glandular / over the muscle solution would work long term. I was worried about ptosis and needing a lift later to fix sagging and drooping. After lots of research on my particular issues, I went with the surgeon whose solution was to use part of the previous pocket (the neo subpectoral pocket repair), gala flex (the same thing they use for hernia repair) to create an internal support structure, and do a fat graph to fill in where the creases had formed from the animation deformity. This surgeon was also one of the "final round" choices from my initial look into augmentation. I really wish I'd have picked him initially!

I'm only 10 days post op on the revision. One side is complete perfection! The other side looks alright from the front but from the side , looks droopy. The infra-mammory fold is higher on that side causing some sagging and truthfully I'm nervous. It may resolve as things settle into place and swelling dissipates. My surgeon had very complex problems to solve; both of my issues were difficult plus he had to fix someone else's work. I don't want to imagine how things would have turned out had I selected a different doctor or opted to go sub-glandular. I'm going to keep the faith and remain hopeful that I didn't trade one problem for another. It's too early to make any judgments. Besides after everything heals, I would think (and hope) it can be adjusted with another fat graph or other small tweak if it doesn't resolve itself.

I will try to update this review after more time has passed. Good luck and do your homework on your surgeon! Besides verifying he is good at what he does, ask what his/her revision rate is. Find out his/her method of problem solving and what options are available for what you want to do. And finally, be sure what you want is realistic and will work long term for your body. Set your expectations accordingly. From the data I've looked at, it gets harder and harder to get good results with multiple revisions.

And my pictures didn't upload with my review...Adding them now; fingers crossed it works.

Also, I want to add a couple of other things I've thought of that I learned from my experiences .

With my first surgeon, I was so confident about his skills that I didn't ask him about revisions. During your consults, ask about revision rate - both quantity and cost. In other words, how many augmentations performed by the surgeon need a second surgery to get the outcome desired and does the surgeon charge for that revision (some don't but may require the facility and anesthesiologist get paid). The answer will tell you about the practice. If they don't track how many revisions are done by their office, chances are that isn't the only detail not analyzed.

Be sure that you are clear about what you want, outlining priorities that are realistic for your body/tissue type, but also be clear about what you don't want. With the first surgeon, I explained about the sport I do and all the physical training it requires but I didn't ask about future physical restrictions or limitations, i.e. that I didn't want to give up doing push ups. I thought that was implied. At a follow up, since I was healing quickly, I asked when I would be able to include push ups in my work outs. He told me never, unless I wanted the implants to migrate out under my armpits. I realized then he did the augmentation he wanted and was most comfortable with and didn't take my lifestyle into consideration. A surgeon may have tried and true processes s/he uses with good reason but may not communicate the down stream consequences. You don't have the same benefit of extensive schooling, training, and experience. Even if you research all about implant types (there are as many as there are cars on the planet) and placement, other factors are in play...and you don't know what you don't know. In my opinion, a good doctor wants an educated patient and should be willing to explain everything about your procedure because that will create clearer expectations. But of course to some degree, there will always be a level of trust involved.

I should clarify that I marked "not sure" as it is too early to tell the final result. I thought I would be able to update the field later once I'm fully healed. Message to website administrators - you might consider making that field editable.