I am 7 wks po. I had a donut mastectomy, breast augmentation with silicone, round, under the muscle 425ccs. My PS and I had agreed on 425ccs for the left and 375 ccs on the right. when I awoke from surgery he decided on 425 ccs for both. Was the mastectomy even performed. Was it a mistake to not use the smaller implant in the saggy one? Also with the lift should my aerola be smaller than it was originally? There doesn't seem to be much of a change. It has not dropped like the left one.
What is Wrong with my Breasts? There Doesn't Seem to Be Much of a Change? (photo)
Doctor Answers (10)
Breast change after donut mastopexy and breast augmentation
In the overall scheme of things you are very early in the recovery phase.
A donut mastopexy temporarily tightens and flattens the skin envelope of the breast and it takes months for the final breast shape to become apparent.
I think you should allow six months for your breasts to settle in. I think you will be pleasantly surprised at your long term result.
Breast Asymmetry after Breast Augmentation/Lifting?
Thank you for the question and pictures. Some degree of breast implant pocket asymmetry and differential “settling” of the breast implants is commonly seen after breast augmentation surgery. Whether or not this will be a long-term issue that may benefit from revisionary breast surgery will need to be evaluated anywhere six months to one year after the procedure was performed.
In the meantime, I would suggest continued patience and continued follow-up with your plastic surgeon.
I think you meant a donut mastopexy which is basically a nipple areola lift. It looks like it was done.
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Donut Mastopexy and areola size
In general the donut Mastopexy has the tendency to increase not decrease areola size unfortunately. At 7 weeks it is still very early in your recovery and things may settle out just fine. I usually recommend not judging the results until about 6 months post op. Good luck.
What is Wrong with my Breasts? There Doesn't Seem to Be Much of a Change?
Comparing the posted before and after photos I must say the result though asymmetric is better than the before. Additional revision surgery is needed.
Asymmetry Resembles Pre-Operative Appearance
While it is still too early to tell for sure, it appears as if your breasts have the same shape and characteristics as they had before the surgery. Both implants need to "settle more" so that the implant goes down and your areola go up...you should be wearing a Breast band 24/7. Ultimately, you may need repositioning of the right areola to better match the left but first let things heal.
Asymmetry following a doughnut mastopexy and breast augmentation
At this point it is difficult to assess the if your breast volume is appropriate but the obvious problem is asymmetry. The right implant is higher than the left and there is some degree of pseudoglandular ptosis. This is when the implant, placed under the muscle, is held in a high position and the breast tissue sags and falls off of the implant. It is still very early in your post operative course and with time the right implant could drop allowing the nipple to rotate into a higher position. If your symmetry does not improve over the next 2 - 3 months then you may need a revision. This could include either a release of the capsule on the right side or a revision of the mastopexy.
You've asked about a couple different things your PS did, and I presume because you're not satisified with the result.
First you have significant pre-op asymmtery, so persistent asymmetry is an expectation not a complication. It is your surgeons job to identify and explain this pre-operatively so you have realistic expectations of surgery.
Second although the breasts look different, I think the overall volume is similar so don't think implant size is the issue.
Last, you have circumareolar incisions, so a "donut" or circumareolar mastopexy was indeed performed. The areolar size can be adjusted based on your desired size, and this should have been discussed pre-operatively.
The question is did you need a larger, circumveritcal or inverted T/Wise pattern lift on the right, a dual plane release, lowering of the IMF or a combination of all of the above. This is hard to asses without an exam and measurements, but can help camoflague your asymmetry.
Overall, I beileve the real mistake made was inadequate pre-operative counseling about the options, your pre-existing asymmetry and your expectations/realistic results. Your surgeon is now behind the eight ball with a reuslt that doesn't match your expectations. I spend more time with my patient's pre-operatively discussing all of the above issues, as then our expectations are aligned and my post-op visits tend to be very smooth with both the patient and myself satisfied.
2 months post-op is still on the early side
Although 2 months post-op is still on the early side, I agree with you that there is some asymmetry still. Furthermore, your nipples still appear low. The right breast implant is still higher than the left, and unless this changes, it will lead to persistent asymmetry too. My best suggestion is to make your surgeon aware of your concerns early, open the dialogue and hear him out, then wait about another month or so to allow things to fully settle. If there is not a change by 3 - 4 months post-op, I would consider a revision to reposition implants/change implant size if needed to improve symmetry. Good luck.
What is Wrong with my Breasts?
The incision around the areola is the incision used for the donut mastopexy. The postop photo looks to me about what I would expect in terms of size change for implants of that size.
There is some asymmetry, and that is common early postop, as the implants will "drop" each at its own pace as the pectoral muscles relax to accommodate the implants. It does look like the breast folds may be uneven. I can't quite tell from the preop photos if that was the case before surgery. If uneven, that would be a contributing cause for the asymmetry.
Allow at least another month before evaluating the outcome. At that time a review with your surgeon is appropriate, and if needed with a second opinion consultant.
All the best.
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