AboutAlan M. Engler, MD, FACS Expertise Dr. Engler has answered over 2700 plastic surgery questions for Allexperts. His expertise is in cosmetic plastic surgery including breast surgery (breast enlargement with implants, breast reduction, breast lifts), liposuction, eyelid surgery, tummy tucks, facelifts etc.
Dr. Engler has been listed as one New York`s Top Doctors, and as "One of the World's Most Famous Aesthetic Surgeons" (Aesthetic Surgery, TASCHEN Books, Angelika Taschen, Editor). He is the author of 4 books, including "BodySculpture" (a best-selling plastic surgery book on breast surgery, liposuction and tummy tucks), "EyeScapes" (Plastic Surgery of the Eyelids), "Restylane," and "The Slim Book of Liposuction."
Dr. Engler has two US Patents for surgical instruments that he's designed, and has appeared on numerous television shows, including The Tyra Banks Show, The Ricki Lake Show (four times), and the Dr. Keith Ablow Show. Videos of his appearances are available on YouTube (SEARCH FOR "DR. ENGLER"). His website is www.bodysculpture.com.
Experience Dr. Alan Engler is a board-certified plastic surgeon in New York and the author of BodySculpture - Plastic Surgery of the Body for Men and Women (ISBN 0966382749) one of the top-selling plastic surgery books on amazon.com, barnesandnoble.com, etc.
Education/Credentials Dr. Engler graduated from Yale University (undergraduate) and the College of Physicians and Surgeons of Columbia University (medical school). He did his residency training in General Surgery and, after that, Plastic Surgery, at the Montefiore Medical Center in New York. He is on the faculty of the Albert Einstein College of Medicine in New York.
Question Hello Dr.Engler. My fiancee, 40 had implants three weeks back. She is very fit, slender and about 5'8' 120 lbs. We consulted two physicians who agreed that 300 cc silicon gel was the best size to best match the proportion of her frame - during surgery the doctor chose 290 due to the tightness in her chest muscles. The implants were placed under the muscle tissue which from my reading is most commonly done.
The swelling following surgery was not unlike what most say they see and her recovery is nearly complete now with full motion and no pain.
We see as does our doctor that when she raises her arms, there are what is explained, muscle fibers that stretch and form wrinkle like ridges in the skin under both breasts that are one inch or so long. Our doctor says they will go away after time but it looks terrible.
Our biggest worry is that now and our doctor agrees, is that the shape of the breasts is wrong and that he needs to move the implants from under the muscle to under the glands because they are squeezed too tight and will not spread out correctly resulting in the bad shape.
While he is not charging to do so, we still have a second surgery, additional hospital costs and wonder if this should had been noticed during the initial surgery. Our doctor has great credentials and is part of a team the goes to South America to do charity work on children with deformities and we have seen his work.
Questions: is changing the position of the implants going to solve our problem; should these muscle strings under the breasts be common; would the problems we face be something that should had been determined initially?
Thank you for your generous time in responding.
Rick
Answer from Dr. Alan Engler
www.bodysculpture.com
Hi Rick,
I'm sorry for the issues the two of you are facing right now.
It is very hard for me to render any sort of an opinion on this since I did not see her before, did not see what happened during the surgery, etc.
However, I would say the following, in general:
1) The bands under her breast are more likely tented up skin that just has to stretch out over time than muscle bands. There are actually only a few strips of muscle there (even when implants are placed "under the muscle" it is really only the upper 2/3 or so - depending on how low the breasts are - that is actually covered by muscle). Either way, though, I would just wait that out and expect it to stretch over time.
2) I'm not sure that I would rush into reposition these implants. 290 is not a huge size for someone who is 5'8", and I would think that, as with the first answer, the muscles will stretch over time and the breasts will appear less flattened. And putting them on top of the muscles means that you will see and feel the entire outlines of the implants much too easily (in my opinion). I very rarely put implants on top of the muscle, and it is almost always for small implants relative to the existing amount of breast tissue.
You can send me some photos at alan.engler@bodysculpture.com and I'll take a look. But short of that, I'm not sure what else to say at this point except that I would prefer to give it more time than to rush in to put the implants on top of the muscle.
Finally, the costs for redoing surgery are not always absorbable by the surgeon. There are rarely absolute answers and while surgeond do not typically charge very much, if at all, for the surgical fees in the event that a revision is necessary in the early post-operative period, additional fees - including the anesthesia and facility fees - are typically out of the surgeon's control. That being said, each surgeon has his or her own policy in this regard.
