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

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.

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Bottoming out after a breast lift

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
4.5 out of 5 stars 12 reviews

Unhappy with mastopexy

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. 

Breast Lifting Revision?

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.

Breast lift asymmetry

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 115 reviews

Mastopexy gone wrong

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.

Vertical mastopexy

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 14 reviews

Your vertical mastopexy can be "fixed"

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

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 33 reviews

When is a "vertical mastopexy" not enough?

In my opinion, the choice of a vertical mastopexy in your case was not what I would have advised because you had too much extra skin and laxity to go with less than a full T incision pattern.  You can still salvage this by going back and doing a crease incision and taking out more lower pole skin and tissue and this will also pull the nipples down a bit.

There are surgeons who believe you can do all reductions and lifts with just a vertical scar but I think your case nicely demonstrates that this just isn't the case and that there will always be a role for a well performed fullT incision lift or reduction.  Good luck to you.

 

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.