My Right Breast Never Dropped and Now my PS is Telling Me That He has to Re-Operate

BA performed 1 month ago. The next day my bandages were removed, and my right breast was significantly higher than my left. The doctor assured me that it would drop after the muscle relaxed. I'm 5 weeks PO and it's in same exact place. Stitches were removed 10 days PO and he showed me on how to do my daily massaging, which I did religiously. I also wore the strap 24/7. I had a checkup last Friday & he says that he has to re-operate. I don't think that he made the pocket big enough. Opinions welcomed!

Doctor Answers (10)

Don't rush into surgery without a plan

+2

Make sue your surgeon explains to you what he thinks happened and what he plans on doing to correct it Sometimes reoperating is necessary but you need a careful plan as to: -when to operate -analyze your preop photos -analyze your postoperative result -have a detailed plan as to what will be done at the time of surgery It would be helpful to post a preop photo. Did you have asymmetric breasts prior to surgery and were your breasts droopy? Any surgeon will have their share of complications or problems. Just make sure he knows how to fix it and explains to you what he is going to do.


Boca Raton Plastic Surgeon

Implants sitting too high

+1

To start, there is an obvious asymmetry of your nipples the right being lower than the left.  That said I feel both implants are sitting a little high, right more so than left.  To address this may require an inferior pole capsulectomy, removing the lower half of the capsule surrounding your implant to allow the implant to drop.  At that point, in the sitting position, I would reevaluate the nipple position with consideration of raising the nipple in the form of a lift.  The nipples should be centered on the implant which is not currently the case.

Roger J. Friedman, MD
Bethesda Plastic Surgeon
5.0 out of 5 stars 6 reviews

Breast augmentation

+1

I'm sure you've read all the opinions below and can see the wide variety of causes for your situation. However, a hematoma is very unlikely as you would have had some visible bruising by now and I didn't see any in the photo nor did you mention any. A seroma is also highly unlikely as these are very rare in primary breast augmentation. It appears from the first photo that the implant is just sitting very high. A hematoma or seroma might look similar at the top but the entire breast would be enlarged and it looks like on the lower portion of the right breast there is no fullness. I couldn't tell you why the implant is sitting that high right after surgery. Your surgeon would have the best idea as to the cause. It does looks like your nipples sit a little low and that you might benefit from a small lifting procedure as well.

David E. Kim, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 46 reviews

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Implant not dropping wait prior to revision surgery

+1

Miss/Mrs. DDMarie,

I am also sorry to hear of your situation.  Thank you for the pictures which allow us to better understand your experience.  The right implant does appear to be higher than the left.  It is very difficult for any physician to determine as to how a persons body will heal and thus revisions are sometimes necessary.  Prior asymmetry in your breasts and/or the presence of breast droopiness before augmentation may be enhanced postoperatively if other procedures are not included in your augmentation.  I usually wait about 3 months after my initial procedure to determine what if any revisions might be necessary.  An explenation of the planned  procedure for the revision should be very detailed; will he/she do a breast lift (mastopexy) also at the same time; will he/she adjust the capsule, how much will be the  charge for the revision?  With your current pictures it is my opinion that you might need a revision of the pockets on both sides to equalize the positioning of both implants and also a breast lift.  As stated before I would wait at least 3 months from your operative date to allow your tissue to heal, and the swelling to subside.  

 

Ernesto Hayn, MD
West Palm Beach Plastic Surgeon

Implant issues

+1

At least from the photos, it appears that the right breast implant is high.  An exam is in order, but from the photo it looks like the nipples on both sides are pointing down a bit, and I am not sure if you need a small areola lift or repositioning of the implants on both sides.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 17 reviews

It is a challange to make a diagnosis by photo.

+1

You did a great job posting photos demonstrating the assymetry following your surgery.  Unfortuantely, there are many potential causes for this problem.  The incomplete list of problems include acute fluid collection (seroma, hematoma), assymetry before surgery, technical aspects such as inadequate pocket dissection, malrotation of shaped implants, etc...  Your definitive diagnosis witl necessitate at least one other examination by an experienced plastic surgeon. Within my stated partial list of problems, only the acute collection of fluid necessitates early semi-urgent attention.  Otherwise you will have the luxury of time to clarify the cause and decide on the best treatment plan for your situation.  So do not rush into a plan of action.  Best of luck.  

Chen Lee, MD
Montreal Plastic Surgeon
5.0 out of 5 stars 4 reviews

You had hematoma and capsular contracture now

+1
Your immediate post augmentation is consistent with hematoma. You have developed contracture and will need revision. You may also need revision on your left side at the same time. Your left implant is high too and will be noticeable if you only fix the right side.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.5 out of 5 stars 56 reviews

Breast Augmentation and Re-operation

+1

Hello DDMarie,

I am sorry that you are experiencing problems after your breast augmentation.  Based on what you are telling me, you had an accumulation of fluid immediately after your surgery, probably blood or serum (hematoma or seroma), and it appears that you still might have some fluid that is still present.  What is certain is that you have capsular contracture.

It concerns me that you were told it was your muscle contracting, and that you were told to massage it and given a strap. Massage and straps do little in these situations.  Even after uneventful surgery, massage has never been shown to prevent capsular contracture.

Based on a thorough history and physical exam, there is a possibility that fluid can be extracted from the implant pocket, which might improve the appearance of your right breast immediately.  To definitely deal with this issue though, a second surgery will probably need to be performed, whereby all the scar tissue is removed and a drain placed for about a week, to prevent reaccumulation of any fluid.  A new implant should be replaced to minimize the potential for a recurrent problem.  A definitive surgery should not be attempted for at least 3 months.

Non surgical treatments have been mostly disappointing, including the use of drugs like Singulair, Accolate, non-steroidal anti-inflamatory medications like Motrin, antibiotics, or steroids.  External ultrasound has not been effective either.

Please go see someone with a reputation for being a breast surgery expert; someone who is certified by the American Board of Plastic Surgery and is a member of the American Society for Aesthetic Plastic Surgery.  His evaluation and recommendation will be key to getting the good result you were hoping for.

Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 29 reviews

My Right Breast Never Dropped and Now my PS is Telling Me That He has to Re-Operate

+1

Thanks for posting your photos. More is going on than just a non dropped implant on the right. I'm concerned of a hematoma/seroma on  the right. Please obtain additional in person opinions. 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.5 out of 5 stars 62 reviews

Revision Breast Augmentation

+1

Dear DDMarie,

I am sorry to hear about your condition. It appears that your right breast implant is too high, and a revision is likely needed to lower the implant. There are many reasons this could occur, including pre-existing breast asymmetry, pre-existing sagging, and inadequate creation of the implant pocket. I would discuss your concerns with your surgeon.

Warmest wishes,

Larry Fan, MD
 

Larry Fan, MD
San Francisco Plastic Surgeon
4.5 out of 5 stars 10 reviews

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