There is not enough info to answer questions. However, I believe moderate profile silicone implants over the muscle is the worst possible combination. I only recommend saline hi profile under the muscle.

Published on Jul 11, 2012

In general… Going under the muscle will decrease upper pole projection. You may try a textured implant that is larger than what you presently have, But it sounds like you may need a lift. Of course, it is very difficult to assess this without photos.

I wish you the best,

Dr. Gabbay.

Published on Jul 11, 2012

The best would be to do an evaluation, please send an email in to our practice, and we will be able to assist you and coordinate with one of our board certified plastic surgeons.

Thank you.

Published on Jul 11, 2012

Transposition of the breast implant under the muscle may help to keep the implant up. Of course a mastopexy or breast lift will do that. Another option is an acellular dermal matrix sling for lower pole support. This can be conceptualized as an internal bra for the implant that helps to reinforce your own breast tissue.

Published on Jul 11, 2012

There are several options including capsulorrhapy with or without an ADM or Seri and changing the implant location to behind the muscle. While the later is more work and recovery, it is often the better choice for more predictable implant support. Whether or not a lift is needed depends on the amount of skin, breast tissue and sagging you have. There are many options, but most depend on your specific anatomy and goals. An in-peraon consultation is needed in order to provide you with specific guidance.

Published on Jul 11, 2012

I would consider a higher profile implant. Alternately you can consider the Inspira implant which will be a slightly overfilled implant available after June 29th .

Published on Jul 11, 2012

Having implants above the muscle was really a mistake if you had some drooping to begin with. It seems like a good idea at the time but it is like putting a rock in a sock as it weights the breast down. So putting in a larger implant would transiently give you more foremost above but gravity over six months to a year would make you look like you were droopy even more.

I think your options are to place a textured implant in a new pocket on top of the muscle or second only to convert your implant to under the muscle with some sort of acellular cellular dermal matrix support like alloderm or seri. A lift very likely may be in your future. A physical exam is needed because you have so many moving parts. Good luck

Published on Jul 11, 2012

Hello,

Unfortunately, without photographs at the very least, I can only generalize about your issue. If your implants have migrated into the breast tissue envelope, commonly they will hang off your chest in a more dependent position (low). Simply putting larger implants in rarely fixes the problem, as the new larger implants stretch the tissue further and drop down again.

My recommendation for all women considering revision surgery who have implants over the muscle is to place them under the muscle at the time of revision. This will not necessarily stop them from migrating downward again, but it can decrease that risk and give you a host of other benefits too. You may also need a breast lift too, which gives the added benefit of moving your own tissue back up on top of the implant, giving more projection and fullness.

Finally, if your implants are saline, you should consider (seriously consider) switching to silicone gel, and perhaps the newest type of silicone gel implants, form stable, anatomical implants. Silicone gel implants have less of an impact on your body tissues, causing less stretch and thinning, and possibly migration. Anatomical implants are texturized and designed to stay put and have the best long term shape.

I hope this has been a help to you.

Published on Jul 11, 2012

The final appearance of the augmented breast is a cumulative result of the dimensions of the chest wall, the implant, and from the breast, either of which can augment of diminish desired projection, width, and/or movement. If the patient desires higher projection, she can either use implants that have higher profile (projection) or she can keep the existing implants while having the breast lifted onto the implant mound. Submuscular placement doesn't add very much to the overall size. And it should be noted that if the patient really needs a breast lift, at the end of the day, she usually needs a breast lift.

Published on Jul 11, 2012

Without examining you it's difficult to give you a complete answer. One possibility is to replace your implants for form stable anatomically shaped implants that will add some transition to the upper pole of the breast.

Other wise, in my experience the only other way to move the breasts higher on the chest wall is through a standard mastopexy (full breast lift).

Published on Jul 11, 2012

Good morning!

This is a difficult question to answer without a photo, but in general having the implant above the muscle in a woman with appropriate anatomy will actually give more upper pole fullness than having it below the muscle. I can assure you that no one likes the incisions that have to be made in a breast lift- but sometimes it is necessary to get the look you are looking for.

If you are concerned with your outcome, be sure you are seeing a surgeon with a lot of experience in breast surgery- you may want to get a second opinion before proceeding.

I hope this helps.

Published on Jul 11, 2012

Without seeing a picture, it's difficult to gauge where your implants are sitting right now and whether you have any ptosis (sagging). If the breasts are sagging, then doing a mastopexy (breast lift) may give you the result you're looking for. Another option would be to consider also repositioning the implants behind the muscle at the same time as the lift. The problem may be that you are "bottoming out." ,where the tissue between the nipple, and the inframammary fold has stretched out, in which case I often use a dermal graft to serve as an internal brassiere and help support the implant.

Published on Jul 11, 2012

You may need a combination of implant replacement and repositioning beneath the muscle and an skin tightening procedure (lift) but it is essential to be evaluated since your description alone does not provide enough information about your condition. You really should rely on the advice of a competent plastic surgeon who specializes in difficult revisions- look for ASAPS membership as a guide in choosing your plastic surgeon. visit www.surgery.org for the details.

Published on Jul 11, 2012

Thank you for your question.

Without an examination, I would not be able to give you options as to what surgery will achieve your goals.

If you are local, please come into the office for an examination.

If you are from out of the area, please feel free to email photos of yourself and your concerns and I will be happy to review it.

I look forward to helping you achieve your goals.
Tom Pousti MD
www.PoustiPlasticSurgery.com

Published on Jul 11, 2012

This is not a simple answer.

First off, putting implants under the muscle will make your upper breast less full, not more full.

Second, you must determine if your breast mound is too low and/or your nipple is too low. If the mound is too low, use of a tissue support matrix such as ADM or Seri, could support the lower half of your breast implant ("internal bra") to achieve upper breast fullness. If the nipple is too low, you will probably benefit from a lift. Sorry, but if you don't, you will end up with either their "rock in the sock" or "Snoopy" deformity.

Published on Jul 11, 2012

Thank you for the question. One option that may be ideal is a capsulloraphy. This is when the pocket of the implant is sutured and tightened to keep the implant higher or in a more ideal position. The key to getting a gray result using this method is the actual geometry and technique of how the pocket is repaired. Although some also advocate the use of dermal matrix such as stratice I have not found it nenecessary if proper capsulloraphy is done. A Breast lift is only needed when the areola and Breast tissue also need to be lifted. If this is not the case then only a capsulloraphy may be ideal.

All the best,
Dr Remus Repta
Scottsdale, AZ

Published on Jul 11, 2012

When trying to raise the implants on the chest wall, there are two ways that this can be accomplished - either an internal lift where you modify the pocket to keep the implant higher or an external lift where you modify the breast tissue. It really depends on each individual's anatomy. Simply changing the pocket position alone to submuscular may not be enough, but without pictures or an examination, it is impossible to say what would work best in your case.

Published on Jul 11, 2012

Changing implants to a submuscular pocket and performing a total muscular coverage can result in superior placement of the implants and more media fullness. Additionally,fat grafting to the superior medial quadrant of the breast can also help. This is termed a composite breast augmentation. Also, you may require a 360° incision around the areola for a breast lift or if your breast sag is more severe you may require a lollipop incision which is a 306° incision around the areola extending downward in a vertical fashion.

Published on Jul 11, 2012