American Society of Plastic Surgeons
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Raynershine
11 months ago
Answered

From teardrop over muscle to High profile under muscle

URGENT: Hello.Is it normal a surgeon recommend getting a high profile under muscle implant to replace a “teardrop” over muscle implant? This was suggested and performed by my surgeon 3 weeks ago and now I’m left with an empty saggy pocket with my nipple completely below the new implant. COMPLETELY BOTCHED! surgeon now telling me I need a breast lift which he NEVER said before but he insists he did

Procedure: Breast Implant Revision
Type: Question

Replies 7

Debra Johnson
ASPS Surgeon
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If you had a firm breast from a tight capsule, shifting the implant to the submuscular position is the way to try and get you a softer breast (the risk of capsular contraction is much lower if implants are submuscular). If you were switching from textured to smooth implant because of concerns for BIA-ALCL, shifting to submuscular is best since smooth implants stay softer under the muscle than above. That being said, with that switch, you have two wounds, one above and one below the muscle. The breast skin has been stretched out by the implant so in removing the implant, the breast skin is looser and the nipple will drop. With the new implant below the muscle, the muscle is tight and needs time to stretch the muscle and settle into position. There is frequently a short-term mismatch between the two pockets. This is not a "botch". Your breasts need time to adjust, like 4-6 months. Wear a bra to support the breast skin, give it time, and you may not even need a lift.

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Lawrence Glassman
ASPS Surgeon
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Switching breast implant position from on top of the muscle to under the muscle is very common when revising breast implants. It is not uncommon to have changes in appearance depending upon the reason for revision and the operation required. The residual breast skin and nipple can sag off the underlying muscle and implant. With time, the muscle usually expands and the skin will try to shrink. If this does not occur adequately, a breast lift will improve this condition.

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Wendell Perry
ASPS Surgeon

It is way too early to revise a surgery. A second surgery to soon could lead to infection and other complications. Look at a lot of before and after photos and make sure you see a before that looks like you and an after look that you like. Getting more than one opinion might be a good idea.

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Nelson Castillo

Thank you for sharing your question and I am sorry that your current results have not been what you anticipated. It is very common to convert an implant from above to below the muscle and as a result the implant may sit very high on the chest as a result of tissue/muscle swelling leading to a "drooped" appearance to a patient's natural breast tissue. Over time, in excess of 6-8 weeks, you should see gradual improvement in the matching of your breast tissue/skin to the implant but unfortunately without photographs of your breasts beforehand it is difficult to assess whether a lift would have been required.

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Curtis Wong
ASPS Surgeon

Since you are post-op, there isn't much to do at this point besides focus on healing. As for whether your surgeon said anything about a lift, you can obtain a copy of your consultation and progress notes to see if its documented whether a lift was mentioned or not as depending on recall is very very unreliable. There are so many variables that impact an outcome and its best to find out whether a lift was mentioned or not and continue with your surgeon as many have revision policies that would cover problems such as yours. Photos would help others provide more opinions. My own policy covers issues such as yours and if you were my patient, you would be covering the cost of the OR and Anesthesia only. Now if it was mentioned, then you would also pay a fee for the mastopexy but if not mentioned, it would be covered with the revision policy and if I dropped the ball, would even cover all costs. But you cannot claim a 'botched' procedure without getting a second opinion to confirm.

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Enriquillo Clime Rivera
ASPS Int. Surgeon

Hi dear,

sorry you going through this, please try to calm and not rush. you have less than a month of surgery. is difficult to give you a yes or no reply because based of what you are saying many issues come in hand. however yes, in some cases i have successfully chance the size, shape and position of the implant. and yes, that is not the most common thing. having a second opinion on this cases can be a good option that way you gain information and explore another vision of your case.

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Adolfo Sesto
ASPS Int. Surgeon

Hello Rayner. Sorry to know how disssatisfied you are with your results. Your surgeon choice was a good one, I always prefer to place the high profile implants under the muscle to get a most natural look and to avoid migration. 3 weeks is too soon for the implants to make their natural fold, and get down to their place. You should wait at least 4 month to see final results, swollen will go away and muscles will relax. You are still swollen and for sure they are still too high. Be patient. If you need a Breast Lift after you can see the final result it can be performed.

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