Andrew Bonett, MD

Hi, good question. This is a pretty common outcome after any reduction or lift and even happens without the significant weight loss you mentioned. A lot of it has to do with the way the skin incisions were designed and how much lift was required during the reduction. There are other variable during the healing process as well, such as swelling and tension differentials at different points around the circle. We try to distribute these forces equally but there are a lot of variable throughout the surgery and healing process. The good news is you actually have a relatively good shape to the areola that can typically be fixed with a small scar revision under local anesthesia in the office. It may be worth the revision, but remember, most natural nipples and areolas are not perfectly round to start with

Hi Nadia_, based on what you are describing and what I can tell from the photos, it is a difficult situation with a couple limiting factors. First, now that the nipple position is asymmetric, it is nearly impossible to attain symmetry without some form of a lift, even if just a small donut-type lift. Secondly, you desire more cleavage but currently have implants under the muscle which can push them away from center and make more cleavage difficult. Lastly, it seems that you are rather fit and don't have much fat elsewhere that would be available for fat transfer to the breast. Sometimes doing a little fat transfer just to the inner and upper breast can help with that last little bit of cleavage. I do agree with the opinion that a transition to subfascial would help improve cleavage and be less detrimental to your weightlifting. However, you need to be careful because the more you push the implants toward the middle, the more the nipple position can be displaced outward. Something has to give in this situation, and it is up to you and your surgeon to discuss these pros and cons and decided what meets most of your needs.

Hi @hema2, the short answer is no! The main issue with doing these things close together are going to be risk of blood clots. Long surgeries such as a mommy makeover can have a slightly higher risk of blood clot formation, especially if you already have more risk factors. One of the biggest preventable risk factors, though, is recent orthopedic surgery. Since these are all elective surgeries, I would just make sure you space everything out to decrease your risk. I would say at least 3 months apart. You also should consider your "down time" for each. Most people don't want to jump into another elective recovery period when they are just getting back to more activity.

Hi @mainemom, I do think you should have your previous surgeon (or a new one if they are unavailable) take a look. I usually see my patients at least annually to see what natural changes are occurring. Most commonly there will be changes to the soft tissues (breast tissue) that occur around the implant, such as the "waterfall deformity" that you mentioned. Separately, the implant can have issue with capsular contracture, or worsening scar tissue that make it tighter, change the shape, or affect the position of the implant behind the breast tissue. One or both of these things could be contributing to the changes you have seen over the last 11 years. The last thing to consider is that if you silicone gel implants and have never had imaging, then you are overdue for either an ultrasound or MRI to see if the implant is still intact or ruptured. This is the FDA recommendation. It's not an emergency if the implant has ruptured, but at least you know it's time for an exchange. Whether you do another lift at the same time would be a cosmetic concern and up to you and your surgeon

That's too bad that you had to have double jaw surgery after a successful rhinoplasty. As you have already experienced, manipulation of the underlying skeleton completely changes the foundation that the three-dimensional nose sits upon. There are multiple rhinoplasty techniques that can be used to improve the things you don't like, but it is imperative that the orthognathic/double jaw surgeries are complete first. Secondly, I'm not sure if you had the septoplasty covered by insurance but a secondary rhinoplasty would likely be considered fully cosmetic. You'll just need to talk with your surgeon about the particular things you want to correct, and he/she will explain how they can achieve it.