Already Sagging After Breast Lift and Silicone Implants

I finally had a Breast lift and Breast augmentation this Jan. I have 2 kids, 34, 5'7", 160lbs, 38C prior to surgery. I had 550cc Mentor round, moderate profile silicone implants. I feel that they are already sagging and I am unhappy with the lack of roundness on the top and lack of cleavage, and dispoportionate nipples. I don't care if they look natural I want them to look perfect in a bathing suit. What are my options?

Doctor Answers 25

Only a revision will give you what you are looking for.

It seems that your implants have bottomed out and there is significant asymmetry in the size an location of your nipples. I would encourage you to wait at least 6 months from your original surgery to allow things to settle. Then I would do a revision mastopexy to make the nipple areolar complex the same size and location. I would bet you have silicone gel implants that are smooth walled which allows them to move down the chest wall. In my experience I have found replacing these with silicone gel implants that are textured and using a drain until the pocket closes down on the implants can help maintain the higher fuller position which you are seeking.


Orlando Plastic Surgeon
5.0 out of 5 stars 13 reviews

Sagging after breast lift or mastopexy

overall your breasts look fine and your plastic surgery results are reasonable. it is not uncommon to get some asymmetry in the nipple position and the shape. all breasts do re-sag to some extent after a breast lift. You might want to let your surgery to heal and then consider a larger implant in order to get a better cleavage.

S. Sean Younai, MD, FACS
Beverly Hills Plastic Surgeon
4.5 out of 5 stars 34 reviews

Consider revision

It seems to me that you had a skin lift with an augmentation. As a result, your scars are stretching, your areolae are stretching, and your breast and implant are bottoming out. Using your existing scars, you can have a "Vertical lift" which plicates the breast tissue on the bottom of the breast and internally lifts the breast - not just uses the skin.

Lisa B. Cassileth, MD
Beverly Hills Plastic Surgeon
4.5 out of 5 stars 13 reviews

Revisions sometimes provide the finishing touches to sagging, low breasts after breast lift

We have to remember that breast lift with augmentation is one of the trickiest operations we as surgeons perform on the breasts as we are changing almost every measurable parameter of the breasts at the same time, and we are doing it on both sides and trying to get them to appear the same.  In addition, the tissues that we are doing this on are typically stretched out and damaged, and their behavior is often unpredictable.  It goes without saying that even with excellent planning and execution during surgery, the end result might not be exactly what we hoped for.  There are a number of things that we can do to improve things like you mention in your post after such surgery.  One of my favorite things to do to further enhance the fullness of the upper breasts is to do some fat transfer using your own fat to fill in around the implants and provide more volume specifically to the upper breasts.  This is very effective for improving fullness without increasing overall volume significantly or risking further settling of a larger implant or recurrent stretching of secondarily tightened lower tissues.  Things like nipple position or differences in areolar diameter can very effectively be done at the same time.  If your surgeon doesn't offer this as an option, it may be worth exploring that with a second opinion consultation with as surgeon who does, as this could be a very effective solution to your problem.  Good luck.

Already sagging after breast lift and silicone implants?

Hello! Thank you for your question! The mastopexy (breast lift) procedure raises the breast, which ultimately provides a more youthful and perky breasts. This is done by removing the extra loose skin and rearranging the surrounding breast tissue in order to reshape and support the newly formed breast. At the same time, the nipple-areolar complex (NAC) is raised to the ideal position above the fold beneath your breast (the inframammary fold) as well as being placed at the most projecting portion. Oftentimes with age or following pregnancy, the NAC becomes widened and enlarged. This may be reduced in size during the breast lift procedure.

It is common for the breast to lose its firmness and uplifted appearance over time, which is also accentuated with age, pregnancy/breast feeding, weight gain/loss, and gravity. This results in breast ptosis, or sagging of the breast, with a “deflated” appearance. Women seek the mastopexy procedure to regain the previous youthful appearance of her breasts and women report increased confidence, self-esteem, and femininity once achieving this desired shape and fullness. Breast lifts may or may not be performed with implants – the implant would add increased size but also greater fullness in the upper pole of the breasts which creates more cleavage.

I would discuss your concerns with your plastic surgeon.  Increased size of the implants as well as laxity of the native skin do cause increased stretching inferiorly.  Revisions certainly may be considered - allow your surgeon to examine and evaluate you and then go over which procedure(s), if any, will be the right one for you.  Best wishes for a terrific result!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 14 reviews

Revision Surgery Following Breast Lift & Augmentation

            Breast lift performed in combination with breast augmentation is one of the more difficult procedures performed in plastic surgery. When these procedures are performed in combination a large number of variables exist that make this procedure complicated. For these reasons, many surgeons won’t perform these operations together. When they are performed together surgeons realize that secondary procedures will often be necessary.

 

            Your pictures indicate a reasonable result for this type of procedure; however several areas of concern are noted. There is obvious asymmetry, with the right breast and areola being larger than the opposite side. This will eventually require a larger implant on the left side with reduction of the right areola. This type of revision should not be undertaken for at least six months.

 

            Some of your post-operative concerns can’t be addressed with revisional surgery. For instance, recurrent sag and loss of upper breast fullness are related to the biologic behavior of your tissue and size of your breast implants. Using a larger implant might help in the short term, but would make the problem worse over time. Another example is cleavage. This is determined by the position of the areola, which can’t be easily manipulated.

 

            It’s important to have realistic expectations. It’s fair to say that asymmetry can be corrected and scars can be revised. Changes in the breasts resulting from biologic wound healing tendencies and gravity aren’t easily changed. It’s important that you discuss your concerns with your plastic surgeon so an appropriate treatment plan can be formulated to optimize your result.

Loss of upper pole fullness after breast lift and implants

Thank you for your question.  I agree with others that your result is not different from many people who have had a combination breast lift and implants.

It is too early to make a decision about revision.  However if you want more upper pole fullness some form of revision will be necessary.  Wait until you're 6 months postop for full healing before making a decision.  Your 550 cc breast implants should be large enough and adequate to give you upper pole fullness.  Most likely at 6 months a revision to remove more skin from the bottom portion of your breast to lift the implants will be required.  Please discuss your concerns with your plastic surgeon.

Breast lift results

No breast lift result is perfect. I do see your asymmetries and irregularities of the nipple areola complex. Fullness in the upper pole usually means a bigger implant with the lift, but it never stays up as high as I think some patients expect. And I have to say "natural" breasts do not stay that high either unless a bra is puschng them up.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 19 reviews

Breast lift revision or larger breast implant

Since you stated the surgery was in Jan., I assume of 2009.

After 6 months of healing I would revise the inverted T incision, by removing more in the vertical dimension. This should elevate the breast more giving a fuller upper pole effect.

Other choices are a 600 to 700 cc implant (I feel a poor alternative but it is still an option).

Regards

To truly determine what can be done will depend on 1)...

Dear DBoyzMom,

To truly determine what can be done will depend on

1) time from surgery- a minimum of 6 months

2) what your breasts looked like before surgery

3) what level the implants were placed

4) any post operative complications

Revision surgery is an option. The implants can be elevated in position to give more upper pole fullness. The degree as to which the "sagging" can be eliminated is partially dependent on the quality of your tissue. Your implant size will cause some tissue thinning and stretch the skin of the breast to a degree.

With Warm Regards,

Trevor M Born MD

Trevor M. Born, MD
Toronto Plastic Surgeon
5.0 out of 5 stars 60 reviews

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