Mastopexy Gone Wrong?

I'm 2 mos. post-op from a vertical mastopexy. I feel that my breasts look very bizarre. My nipples point in an upward direction and are placed too high on the breast. Also, my right breast is assymetrically shaped in comparison to the left one. I voiced my concerns to the Dr. at my 3 wk post-op visit. He brushed them aside and said that the nipples had been correctly placed and that the right breast was just larger. Did something go wrong with the mastopexy and if so, can things be fixed?

Doctor Answers (12)

Bottoming of breasts with vertical mastopexy

+1

Hi...Dr. Tholen has beautifully outlined your problem and the solution.  The vertical mastopexy is sometimes used too much in that it seems that a horizontal incision can be avoided.  This seems to a patient to be great but in your case, there is too much distance from the nipple complex to the crease.  This by definition needs to be addressed and the skin envelope tightened at the crease.  In your case, this would be a larger excision to support the implants that have bottomed.  Your situation is quite easily approached and your ps should give you options and not brush you off.  Perhaps your ps feels uncomfortable in revising your case and you have to accept that he/she may feel that this is the best it can get.  IT IS NOT THE BEST IT CAN BE!!!  Get other opinions.  Seek someone who has a vast experience in breast surgery.  By the way, your revision will NOT be as uncomfortable as the original procedure.  Your muscle is stretched (assuming that your implants are under the muscle) and you just need to tighten the envelope.  Your nipples can be adjusted in position if needed at the time but an anchor pexy would be the answer before your procedure and it is now also.  You might benefit from a vertical inverted V along with the horizontal  excision also but this would be determined at the table .  A second look can be great to have all details addressed.


Albany Plastic Surgeon
5.0 out of 5 stars 8 reviews

You were not a good candidate for vertical lift in the first place.

+1

If your nipples are somewhere near 21cm from the sternal notch, they are not "too high." Your residual breast tissue is simply "too low," which could be described as "bottoming out." Your skin brassiere needed shortening in horizontal AND vertical dimensions, whereas a vertical, lollipop, or circumvertical lift accomplishes skin tightening in only one direction. Often a vertical lift is"sold" to patients on the basis of "avoiding the inframammary scar," but this is a scar that usually is hidden in the crease and heals well in the majority of women. It was necessary to achieve proper skin tailoring for your breast anatomy.

Sure, some patients can develop hypertrophic (thick, overgrown, or wide) scarring, and some surgeons still have technical difficulty with the inverted-T junction of the breast flaps and their patients develop wound breakdown or ischemic healing problems. These are largely avoidable by proper patient selection, avoiding operations on smokers, and learning the proper surgical techniques--NOT by trying an entirely different operative approach (vertical lift) on every or most patients. 

This result occurred because your surgeon chose to perform a vertical lift when he should have performed a full Wise-pattern ("anchor") mastopexy. Surgeons choose their breast reduction techniques on the basis of training, experience, or habit, and unfortunately, not every patient is a candidate for a vertical mastopexy. Of course, it is easy after the fact to make this assertion, and I'm certain your surgeon felt he was making the best choice at the time. It didn't work out, and every surgeon should discuss with their patient BEFORE surgery what the re-do or touch-up policy is when things don't turn out as (both of you) expected.

If your surgeon is defensive and thinks this is as good as it gets, you will need to find another surgeon and undergo revisionary surgery, which can give you substantially better results. A patient of mine who had a similar situation can be found by clicking on the web reference link below. Best wishes! Dr. Tholen

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
5.0 out of 5 stars 144 reviews

Bottoming out after a breast lift

+1

Symmetry is the curse of plastic surgery and even though the same operation is done on both sides they frequently heal like they are on two different people. You appear to have some nice improvement as you progress and it is possible that this will continue. You are at the 10  month period and it may be time for a reassessment and possible revision to center the nipple over the implant  and revise the mastopexy.  Possibly converting to a vertical type with a shortening of the inframammary segment.  You may need a IMF incision as well.

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
5.0 out of 5 stars 10 reviews

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Unhappy with mastopexy

+1

I can certainly see why you would be unhappy. 

It may be that the nipples are correctly positioned by some standards, but they are way high on the current breast mound.

Correction is possible by converting this to a full anchor pattern lift, and removing a lot of extra breast skin from the lower part of the breasts, and in doing so, lifting the remaining breast tissue. If your surgeon feels this is a good outcome, try elsewhere. All the best. 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon
4.5 out of 5 stars 34 reviews

Breast Lifting Revision?

+1

Thank you for the question and pictures.

I agree with your assessment.  your results can be significantly improved with revisionary surgery. This will likely involve removal of additional skin as well as breast implants repositioning.

Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 792 reviews

Breast lift asymmetry

+1

Hello,

The good news is that your results can be improved/corrected with a relatively straighforward revision.  When patients have significant pre operative asymmetry as well as a significant need for a lift I usually discuss the possibility that a revision may be needed to achieve perfect symmetry.

All the best,

Dr Remus Repta

Remus Repta, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 98 reviews

Mastopexy gone wrong

+1
You look like you need a breast lift. You had very significant sagging, and the vertical lift you had did not do enough to correct your overhang and the long distance from your nipple to the fold under your breast. I can't tell without measuring you whether your nipples are indeed too high (which can be difficult to correct) or whether the excessively long lower pole beneath them just make them look that way. The good news is that you can have a significant improvement quite easily by having the type of lift I think you needed to begin with, and that is the "anchor" pattern or "inverted T" lift. This will shorten that long lower pole distance, make the breasts look better, and make the nipples look less high. The bad news is that you need another lift, and if you can't trust your surgeon to do the right thing, then you should look elsewhere.

Robert M. Grenley, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 73 reviews

Vertical mastopexy

+1
A vertical mastopexy is performed in order to avoid the long scar underneath the breast typical of a standard mastopexy or breast reduction. In your case the distance of your nipples to the inframammary crease is abnormally long giving the breast a bottomed out appearance. Since it has only been two months, there may still be some swelling in the lower portion of the breast, which may go down with time and correct the problem. Otherwise you may need a revision of the breasts to include the inframammary scar, to shorten that distance and tighten the lower portion of the breasts which now appears too saggy.

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 12 reviews

Your vertical mastopexy can be "fixed"

+1

I believe your situation can be improved by converting to a full anchor- shaped or Wise pattern mastopexy.This way the breast mound can be supported from below so that the nipple sits in a centered position. Also some breast tissue can be removed from the larger breast for symmetry. I hope you surgeon will help you with this.

William H. Gorman, MD
Austin Plastic Surgeon
4.0 out of 5 stars 16 reviews

Nipple too high after breast lift

+1

It is possible to place the nipple too high with a vertical breast lift or reduction. The breast will appear full and bottomed out, what was called a 'virginal tilt' to the nipple which pointed upward after reduction many years ago before we knew better. Your result can be improved by reducing the skin envelope under the breast, converting the skin pattern to a 'T' which will help pull the nipple down, front and center on the breast. So good news, there is a solution and you can look much better.

Best of luck,

peterejohnsonmd

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 31 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.