I had a lift / aug 2 mos. ago. 400CC sil implants were put in &a lift done at the same time. I always had saggy breasts but then I lost 130 lbs & went from 44DD to 36A. I didn't expect HUGE breasts but I did think they would be bigger. I'm disappointed about the size. (they are 36D now) See the pics for my problems: lumpy scars, uneven breasts, & nipples point in different directions. I'm terrified but doctor says "Be patient." Should I worry?
Lumpy Scars and Unevenness - Is Something Wrong with my Implant / Lift Surgery?
Doctor Answers (29)
Unfavorable result after Breast Augmentation with Lift
Without knowing what your exam was like before surgery, it is difficult to say for sure what might have caused the problems you are encountering...
On the other hand, it is clear from the photos you did provide that you have a very poor result. I would not expect this to improve over time, and in fact it may worsen as capsules mature...
You are going to need a revision of your surgery in order to achieve a pleasing outcome, but please be aware that the timing will be critical to success... It is very important that no revision be attempted until at least 3-6 months after the initial surgery..
Breast augmentation with lift
Breast augmentation and breast lift together is and can be a very complex surgery with a high rate of complications. At two months and observing your results, I would recommend aggressive massaging (implant-displacement massages) in order to get the implant to settle a bit lower. However, it is also very possible at this point that the implant will not settle and you may require a revision. I would wait until 6 months to make that decision.
Here's what I think is going on. It is very common for implants to "not drop" and stay in a "high" position when breast augmentation and lift are done together. This is referred to as "superior malposition of the implant" and I see patients with this exact situation regularly. It is even more common for this to occur when large implants are placed at the same time as the lift. Anything greater than 300 cc at the time a mastopexy (breast lift) I would consider "large". Usually the solution is to go back release the capsule, sometimes we have to "downsize" the implant, and in some cases even adjust the mastopexy incisions under the breast. If you ultimately want to be larger, you may have to wait until the "pocket" is first settled in the right place which will "center" the nipple better on the breast mound and also this will give you better lower pole curve and shape. You can always swap out the implants for larger ones later. I hope this helps!
James F. Boynton, M.D., F.A.C.S.
Uneven Breast Lift/Implant Surgery
At two months you are still in the healing state. I recommend waiting at least 6 months before considering revision surgery. That being said, I think you will need a revision. Your implants are high, the nipples are asymmetric, the right lateral breast pocket indents, the vertical incision on the right goes below the breast fold. These are too many asymmetries at this point to feel confident in saying the healing process will take care of them all.
Hope that helps and good luck!
Dr. Babak Dadvand
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Disappointing Breast Augmentation / Lift Result
Breast Augmentation and Lift Combination Takes Time To Settle
The combination of breast implant placement with breast lifts can be a difficult operation to get the desired shape and size of the breasts in a single operation. The more saggy the breasts are to start with the more challenging it can be. Once done it almost always appears that the implants are too high and the nipple may appear too low. It takes 3 to 6 months for settling of all of the tissues. Your breast appearance at 2 months strongly suggests that a revision will eventually be needed but it is important to make sure that you have stopped settling before embarking on a subsequent revision.
APPEARANCE POST AUGMENTATION/MASTOPEXY
Thanks for the photos. They are very helpful. From the photos, you appear to have a moderate amount of fullness at the top of the breast. As the implants settle, this will be much less and the nipple-areolar complex will appear more centered. Over time the irregularities along the bottom of your breast will smooth out. It is too early in the healing process to consider any surgical revisions. With massage techniques you can help the implants settle in a more natural position. Scar therapy with silicone can help to soften the scars and improve their overall appearance. I would discuss these avenues with your surgeon.
Augment Mastopexy Concerns
As mentioned by my colleagues, if you have the patience, it is always better to wait for a few months before jumping back in to revise this. But as also noted, it is almost certain you will require a revision. I hope you had an understanding of your doctor's revision policy as many of us have one to help minimize any misunderstandings that can arise from results such as yours.
You will have many issues to address such as implant position and nipple position as well as the vertical scar that has resulted from your procedure so start thinking about what is most important to you and what you will need for you to be a satisfied patient.
As for your size, most doctors will let the patient select a size and not choose one for them. How did you determine what size you would get? If your doctor selected, then you have another issue to discuss with him/her. If you selected, then I would want o know if any breast tissue was excised at the time of the procedure and is the cause of your less than desired size. Best wishes as getting this resolved. I would think your doctor will be very motivated to help see you through this.
Lumpy scars after a lift/augmentation, is this correctable?
Thank you for yor photos. It would've been great to see some preop photos as well. Of the limited views you sent there's some asymmetry, nipples do point to different directions and the vertical scar seems to go below the breast crease or there is some puckering below the crease. I assume that these implants are submuscular and they seem too high. At this time you should wait until the implants settle and your tissues heal and soften up before considering a revision. I believe you will need a revision in the future. There's some controversy about doing augmentation and lift at the same time. I know most surgeons do it, but I personally elected to separate these two operations. Especially in a person with significant weight loss, I prefer to do a breast lift first and do an augmentation later. I see too often when women had an augmentation/lift together they end up with two or more surgeries to correct the initial surgery and still end up with suboptimal results. We all try "to kill two birds with one stone" to save money, time, time off work for recovery or just to get back to our normal lives, but this operation can be a difficult one with very variable outcomes. See examples of breast surgery on my breast site, breastsurgeryseattle. Good luck and be patient.
Post-op lumpiness and unevenness
It is difficult to tell you what to do specifically since you do not show what your original breasts look like. Certainly the results at this time is cause for your concern. The main thing is the mismatch between implant position and nipple position. The scars, the puckering, and the tightness inferiorly will all typically improve over time, but may not improve to the point of being satisfactory. My suggestion would be to wait until the scars and tissues soften and become pliable and then re-assess your concerns and anatomy. Each patient will have their own threshold for revision. If you revise too soon, you and your surgeon may misdiagnose your problem and set you up for a correction that is imperfect as well. My advice would be to wait until 6 months or so or until things are not changing significantly and that time frame is different for different patients. Since revision is electing, waiting as long as you can tolerate.
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.