Botched Tummy Tuck and Breast Lift/augmentation? (photo)

I am very unhappy with the scarring after my surgeries. My doctor has just been telling me to wait and see. I am 7 months post-op. I am also unhappy with the placement of my nipples and have difficulty finding bras that my nipples don't fall out of the top of. I had a tummy tuck w/lipo, and a breast lift and augmentation. I had the surgery because I had a lot of loose skin and stretch marks from childbirth. I am 38 years old. Is a new doctor in order?

Doctor Answers (14)

Concerned about surgical scars and breast results

+2

Thanks for sharing your photos. Even at 7 months post surgery, your scar is still quite early in the maturation process. Your scar has hyperpigmentation which is individual dependent. The central lower abdominoplasty scar is showing some stretching which suggested quite a bit of tension during your abdominal closure. The discoloration generally will continue to get better but often time requires several years to fade. As far as the breasts are concerned, the implants are showing some "bottomming out". This is usually from a combination of large implants and skin laxity. Revision can help but should be done after one year from original surgery. If you trust your surgeon, it's still best to go back to him or her. Think about the reasons why you choose your surgeon in the first place. If these reasons still in place, then he or she may still be the best person to help you improve your situation.

Best wishes,


Los Angeles Plastic Surgeon
4.5 out of 5 stars 22 reviews

Second opinion?

+2

Thanks Suzie for your questions and photos. I appreciate what you are going through and it is reasonable to get a second opinion. As far as your results, the nipples look high because you have bottomed out and you did not make good scars on the breasts or tummy. Overall, the contour of the breasts and tummy looks pretty reasonable. I don't think its a "botched" surgery. When seeking a second opinion be careful using the word "botched" because that is a turn off for many plastic surgeons. In other words, they may perceive you as being unreasonable and tell you to hit the road - scars and all. You'll be better served by being reasonable and knowing that all operations have risks and limitations. Best wishes, Dr. Aldo.

Aldo Guerra, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 128 reviews

Unfavorable Scarring Is Unpredictable

+2

Thank you for your question and photos.  From your photos, I believe that you have had a reasonably good result from both procedures.  Unfortunately you have some hypertrophic scarring of the tummy tuck incision.   This can be managed with silicone sheeting, steroid injections and light and laser treatments to improve the appearance.   After 18 months, it can then be revised to improve it further.  I would not recommend a revision before then, as it is likely to continue to improve.  With respect to your breasts, skin laxity and implant choices can have an impact on the apparent nipple position.  You have what appears to be lax tissues.  You would probably benefit from a capsulorapphy to improve implant position and a repeat lift without moving the nipples.  This combination of maneuvers are likely to improve the problem that you are having.  Best Wishes!

Robert F. Centeno, MD, FACS
Fairfax Plastic Surgeon
5.0 out of 5 stars 33 reviews

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Understanding 'Botched'

+1

Unfortunately, when plastic surgeons perform cosmetic surgery they don’t control all the variables. It’s important to understand that plastic surgeons operate on living tissue. These biologic systems don’t always behave in a predictable manner.

Wound healing and scarring vary from patient to patient and as a result, scarring can be severe in some patients and nonexistent in others when the same surgical technique is utilized.

For this reason, the term botched is inappropriate and probably reflects unrealistic expectations. The overall results of this procedure are reasonable. The variables that can be controlled by the surgeon have been addressed and have resulted in good contour and symmetry.

Unfortunately, your breast implants have drifted inferiorly. This has caused superior malposition of your nipple areola complexes. In addition, you have significant scarring of your breasts and abdomen. These problems are related to your wound healing characteristics and not your surgeon’s performance.

It’s important to discuss these issues with your plastic surgeon. Your surgeon should be able to formulate a treatment plan that addresses these issues, this will probably include bilateral breast pocket revisions and scar revision of the breasts and abdomen. This procedure should be delayed for at least 6 to 12 months to allow adequate wound healing.

It’s important to be patient and have realistic expectations. Having a good relationship with your plastic surgeon will ultimately make this a better experience. 

Richard J. Bruneteau, MD
Omaha Plastic Surgeon
5.0 out of 5 stars 76 reviews

Prominent scarring after a mommy makeover

+1

Your frustration with the appearance of your incisions is understandable.  Unfortunately, even with a perfect surgery, some people form prominent scars because of the unique way that their body heals.  Before I went doctor shopping, I would schedule a follow up with your original doctor and ask him or her if they would consider a scar revision of the area to try and improve things.  Good luck.

Sacha Obaid, MD
Dallas Plastic Surgeon
4.5 out of 5 stars 20 reviews

Botched Tummy Tuck and Breast Lift/augmentation?

+1

Thank you for sharing your photos and the narrative. 

Although I do understand that you would be displeased with the current status of the results, this is not an outcome that I would classify as" botched."

Breast  The issue here is something called "bottoming out." It is more common with lax skin (as in breast skin in need of a lift) and occurs when the implants stretch out the remaining skin.  This can be fixed by revising the lower poles of the breast, and using the excess skin to buttress and support the implant. It's hard to explain without picutres and great detail, but your surgeon will know how to do this. This will raise the implants to the position I imagine they were in just after surgery, and the bras will fit better. 

Abdomen:The contours are actually very good, navel is midline, no dog ears, waistlines are good and are even. 

Scars: These seem to be the main issue. The scars are hypertrophic, and pretty much all of them are. The cause here is almost certainly genetic tendency toward unfavorable scarring. These are largely not in the control of the surgeon. However there are a number of things that can be done to try to minimize them. Topical agents, such as silicone sheets or gel, or mederma and similar products are useful in many patients. Kenalog injections are the "gold standard," not to say they always work. Small amounts of steroid are injected into the scars usually in a series of 3 treatments a few weeks apart. Scar revisions can be done, but there is never a certainty that the thick scars will not recur, so these are usually not suggested unless the other non-operative attempts fail. In this setting, however, when there will be surgery for another reason, the pros and cons are weighed and an earlier attempt at revision might be suggested. 

I don't feel that your surgeon has done anything "wrong" or out of common practice, so I would start there. If you are not satisfied with the plan offered, that is the time to seek another opinion. 

Best wishes. 

 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon
4.5 out of 5 stars 31 reviews

Revision surgery may be beneficial

+1

Hello,

Thank your for the question and the photos.  Depending on what you would like to achieve I think you have several optinos for revision surgery.  Your implants would likely benfit from being higher and thereby your nipple/areola complex would be more centered.  Revision of the incisions could be performed at the same time.  This procedure would essentially be a revision breast lift as well as a revision breast augmentation.  Your abdominoplasty may also benefit from a revision.  Options would include revision of the scar as well as revision of the belly button with or without liposuction of the flank and abdomen.  I would at least discuss these issues and possibilities with your plastic surgeon as a mutually beneficial plan may be agreed upon.

All the best,

Dr Remus Repta

Remus Repta, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 91 reviews

Bottoming out of breast after SPAIR mastopexy is common and requires revision.

+1

It is too early to be judgemental about your scars even though 7 months seems like a long time.  I am guessing that you had a vertical scar only mastopexy.  The distance from the areola to the inframmary crease is too long.  It will not shorten with time.  A revision will be necessary.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 8 reviews

Concerns About Mommy Makeover Surgery Results?

+1

Thank you for the question and pictures.

 Although, the results of your surgery are not ideal,  I would not classify the results as “botched”. I think it will be in your best interests to discuss your concerns and goals in a calm and respectful fashion with your plastic surgeon.   The use of words such as “botched” are  Inflammatory and not helpful.

Ask  your plastic surgeon to demonstrate examples of similar “problems” he has helped patients with in the past. If, after this communication process, if you're comfortable that he has the ability to improve your situation, you will be best off allowing them to do so. Otherwise, “a new doctor may be in order”.

 Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 719 reviews

Unhappiness after tummy tuck and breast surgery

+1

Your surgery certainly does not appear botched, but may well benefit from some creams, laser treatments, and possibly relatively minor revisional surgery.

Every doctor in RealSelf must occasionally do revisional surgery.  This is the nature of surgery.

It's your call after a frank discussion with your surgeon whether you like the surgeon's subsequent plan or not, and up to you to choose whom to select for your next procedure, if indeed you decide on that route.

 

 

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 92 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.