Muscle didn't cover implant?

[wants2doitagain]

Hi,

I posted this on the Complications forum and a moderator suggested I pose my question here:

I had my breast augmentation in 05/07. I didn't notice any problems until a year after my surgery. I went back October 2008 b/c the upper pole fullness & firmness in my left breast was alarming to me. At that time, I was diagnosed with Grade II CC in the left breast. He also made the comment about the muscle not completely covering the implant. I can feel the left implant - especially on the side and bottom of the breast. The right one is perfect - couldn't ask for a better, more beautiful result.

I can't find any information to help me understand what happened with the left one...is it a pocket issue? Why wouldn't the muscle cover the implant? I'm really bummed out right now b/c learned today that having 1 redone is going to cost me what I paid for the whole surgery a little less than 2 & half years ago.

I'm going to call tomorrow to see if he is willing to prescribe me Accolate as I don't know what else to do about the pain from the CC. I wasn't expecting this, so I need time to save. Aggressive massaging does not deliver relaxation of that pressure consistently (sometimes it feels better; sometimes it makes not difference). I was not advised to massage after my surgery.

I have 420 cc (right overfilled to 450) textured saline unders, crease incision.

Thank you so much for your time.

[Dr. Mele]

Dear wants2doitagain:

When an implant is placed behind the muscle, it is never completely covered. The outer portion of the implant, especially lower sticks out from under the muscle. If you have a capsular contracture, you have scar tissue that has tightened around the implant. This scar is the pocket. Sometimes this can further expose the implant by retracting the muscle upwards. With a capsulotomy or capsulectomy this can be reduced.

For breast cancer surgery, complete muscle coverage is often desirable. To accomplish this the external oblique and latissimus dorsi muscles are sometimes raised to cover the portion of the implant that the pectoralis does not. For cosmetic surgery this is not normally done as it increases the risks and discomfort of surgery, usually without any benefit.

Also textured implants tend to feel more firm because the scar attaches to the implant instead of sliding over it. While texturing has been used historically to reduce capsular contracture in early silicone gel implants, texturing to reduce capsular contracture for saline implants under the muscle is not well documented. If you are happy with the other side, then replacing just the one with same implant makes sense. If you were changing sizes and replacing both, I would considering using smooth round implants.

Your plastic surgeon has more information with which to make the best decision for you. To answer you questions completely, I would need to see you in my office. You might considering seeing another plastic surgeon for a second opinion to get a more detailed and accurate answer than I can supply via the forum.

[wants2doitagain]

Thank you so much. I had a long conversation with my PS and he made almost the same recommendations as you (except he mentioned going with the gels instead of saline again - although he didn't say smooth or textured, but I will make it a point to ask - thank you for mentioning that). I feel very comfortable going back to him to work through this.