under muscle

Q: One Week Post Op Breast Augmentation..complications

Submitted by Q-A from clee on Sun, 05/15/2011 - 11:17

On 5/11/11 I had breast augmentation, under the muscle thru the armpit. The day after surgery I noticed the right breast was significantly more swollen/higher than the left and deep purple bruising appeared down the entire right side of my torso to my hip area. Three days after surgery a "new" bruise with slight lump appeared under the right breast and bruising has spread under the breast. Have seen my PS and he put me on muscle relaxers and icing every hour with follow up on 5/23/11. Normal?

A: Submuscular placement esp via axilla is more painful

Submuscular implant placement especially through the axilla is more painful with high degrees of swelling and bruising as the lower portion of the pectoralis often must be bluntly dissected in "blind" fashion to obtain an adequate pocket. It is not uncommon to have muscle spasms, pain, and more bruising than with the more direct approach with other incisions. This may take several weeks to improve.

Q: Breast Explantation Due to Intracapsular Rupture with Fluid Build

Submitted by Q-A from clee on Sat, 05/14/2011 - 09:07

fluid build up in my right breast, ultrasound showed there is a thick film of capsular around my implant. Look swollen but no pain. I went to 2 surgeons, one said to remove implant without removing any capsules nor stitch up the implant pocket. While the other one will remove all capsules, stitch up pocket.

My implants are under the skin and they're saline. I have them for 7 yrs. Which one should i go with? Will the fluid goes away so i can leave them in since I have no pain? Please advise.Thx

A: Not really understanding some points...your clarification necessary

You mentioned that you have saline implants for 7 years, yet they are ruptured with fluid and swelling. Saline ruptures lead to deflation and their treatment is by replacement usually with assistance of the manufacturer provided the parameter of the warranty are followed.

Silicone is a different matter. 7 years ago there was a moratorium on their placement. Ruptures silicones should probably be removed.

If you are having exchange of implant, then either a pocket exchange or capsulectomy would be wise since the capsules are thick according to your imaging studies.

Q: Palpable Implants in a Thin Woman - Problem or Normal?

Submitted by Q-A from clee on Fri, 05/13/2011 - 12:21

12 days post BA - 250cc silicone unders.Today I can feel implants under the bottom of both breasts; the right I can see protruding along the suture line (sulture line is clean). Can actually palpitate the edge of the left breast at the corner near clevage. Is this normal? My PS is a 90 min international flight away and I won't see him until next Thursday. I have been wearing the strap 24/7 but will this make it better or worse? Does this affect wearing a bra?

A: Looks fine.

Your photos show the implants in good position and nothing that you describe is alarming. Just continue with what you are already doing.

Q: Left Breast is Shrinking 3 Months Post-Op Breast Augmentation

Submitted by Q-A from clee on Fri, 05/13/2011 - 11:46

Hi there, I had my augmentation on January 18th of this year. I had saline under the muscle surgery. My left breast was slightly lower and slightly larger before my augmentation so my doctor tried to even things out by putting 20 cc more saline in my right breast. 570cc in my left and 590cc in my right to be exact.

As you can see from the pics things looked pretty even on surgery day but as time goes on it seems like my left breast is continually shrinking. PLEASE HELP!!!

A: Implant deflation likely

Implant deflation can result from rupture of the device or valve failure. Rupture presents with a rapid deflation over 1-2 days. In your case it has been more insidious with likely a leak at the valve giving rise to a progressive but slow diminution of size. Most major manufactures have a warranty program in place to assist in the cost of correction. It might be a good time to review the particulars of the warranty. Good job with your photos as it is more information to base an opinion.

Q: Will my Implant Drop Into the Pocket?

Submitted by Q-A from clee on Fri, 05/13/2011 - 10:36

I am 3 weeks post op from having a breast augmentation. I was a small B and they were low and very loose. I am 5'9 and went with saline under the muscle, I had a crescent lift on the right breast which was my larger breast.

I had 550cc in the right breast and 600cc in the left breast. My concern is that the right breast is very RECTANGULAR, and the implant is obviously high, when I bend over my saggy small breast still dangles and my implant is in my chest wall. Will it drop into the pocket?

A: Submuscular implants with mastopexies can be problematic

Subpectoral augmentation with mastopexy tend to be problematic as then lax tissue mastopexy tends to slide over the top of the muscle over time leading to a double bubble type of deformity. The submuscular implant tends not to drop and may accentuate the deformity with descent of the breast.

You are still early after surgery and might respond to breast garment straps to externally push the implants inferior. At the lest it might prevent further migration superior.

Hopefully this will address your issue. However, if you have the misfortune of requiring a revision then discuss with your surgeon the possibility of having submammary repositining of implants with cohesive gel and mastopexy.

Q: What are the Risks of Capsular Contracture with Vitiligo?

Submitted by Q-A from clee on Fri, 05/13/2011 - 08:17

I am 22 days post BA (250cc silicone unders). I have vitilago (which some doctors consider an auto-immune disease and some would not) for 38 years that has periods of remission and advancement.

I take no medications nor treatment. My PS assured me that my risk of developing capsular contracture was the same as any other patient. What are the risks? I am massaging often during the day but worry about any tightness that I experience. My next check up with PS is in three weeks. Thank you.

A: Vitiliigo does not affect capsular contracture

Vitiligo does not affect capsular contracture.  Massage is unproven but very popular recommendation.  I do not recommend massage for textured implants early after surgery as it may affect its ability to adhere to the pocket.

Q: Strattice Breast Augmentation Revision: Uneven and Bumpy

Submitted by Q-A from clee on Fri, 05/13/2011 - 07:45

I am two days post of from a breast augmentation revision. I went from approx 400cc saline under muscle to 375 silicone moderate profile plus under muscle.
Strattice was used laterally and i think underneath as well (the old implants had shifted into my armpits.)
I'm 5'1 99lbs. I have drains too. The outsides, by my armpits, have a concave indentation in them, and it's swollen under my armpits in an uneven way.From front view they look uneven and one almost saggy?? I'm a little concerned.

A: Too early to worry following breast implant revision

Revision breast surgery especially attempts to control pocket with implanted materials is substantial surgery that will swell and undergo many changes over the following weeks to months. Two days is too early to be concerned.

Q: 600cc silicone implants look small on me

Submitted by Q-A from clee on Thu, 05/12/2011 - 03:13

My first ba I had 340cc overs mod profile and was unhappy as they looked too small. I had my 2nd ba 3 months ago and went for 600cc HP silicone under the muscle. I was really gutted to find I still haven't got the desired projection I was after. My surgeon said it's because I have a high rib cage which is why my implants do not project much. Should I consider a ultra high profile saline implant or just accept the fact boobs don't look big on me??? Please help!!! Thanks

A: Sizing an implant to achieve a desired shape and projection can be a challenge

Sizing an implant to achieve a desired shape and projection can be a challenge. The final projection and shape achieved depends on the following: 1) the underlying chest wall supporting the implant. A flat foundation will allow the implant to fully express its projection whereas a tilt to the chest wall will result in loss of or uneven projection to one side. 2) from the underlying shape of the implant. The actual measured dimensions of your implant to the dimensions of your breast envelope is more important than the brand model marketed. 3) the tissue plane of implantation and its resistance to stretch is another major factor on both projection and the visibility of the implant margins. As surgeons, we can only control the selection of the implant model and the tissue plane of insertion. Perhaps you should have another visit (with your surgeon or another experienced opinion) to review the various suitable dimensions of implants to be tried via sizers in the operating room to better approach your goals. Furthermore, submammary placement is more likely to achieve the full implant projection then submuscular placement, however, the implant (especially saline implants) will show ripples and edges in this submammary plane.