Andrew Freel, MD

You have a complex problem with the tissue stretching out inferiorly, secondary to the weight of the implants.  There are multiple ways to correct this problem - remove the implants vs. ADM vs. smaller implants, etc.  Larger implants alone is not the answer and will only worsen your problem.  This is a difficult problem to correct, and different plastic surgeons may have different solutions to correct this problem.  My advice would be to meet with a  few different surgeons and after multiple consultations, choose a Board Certified Plastic Surgeon who has experience correcting this problem.  Be sure to choose someone that you are comfortable with their plan.

It is abnormal to have recurrent bouts of redness and discomfort along any incision at 14 months after surgery.  Any sutures used should have resorbed at this point, unless permanent sutures were used.  It is best to see your surgeon, as only that physician would know exactly how the procedure was performed and the best way to treat your problem.

Liposuction is going to give you the most effective/ definitive result.  You may have some improvement with Coolsculpting, but liposuction will definitively remove the fat.  Coolsculpting will take multiple treatments to achieve the desired effect, and it very possibly may not achieve your desired results even after multiple procedures.  The cost will probably be cheaper also with one liposuction procedure versus multiple Coolsculpting procedures.  Good luck and make sure to see a Board Certified Plastic Surgeon achieve your best results.

Breast implants do occasionally bottom out.  There are many different causes to this problem, and surgery is required to correct this problem.  You have received 4 different answers from 4 different surgeons.  This means that there are many different ways to correct the problem.  Each surgical opinion is based on personal experience of the surgeon.  One technique may work well for one surgeon, and may not work for a different surgeon.  When deciding which procedure to undergo to correct your problem, choose the surgeon/surgical plan that you are most comfortable with.  Also, be sure that the surgeon is a Board Certified Plastic Surgeon and has experience with these types of problems.  Ask to see before and after photos of these types of procedures.  And you can be back to normal after successful surgery.  This is a correctable problem.

Breast implants are man made devices and at some point, all implants will fail.  The million dollar question is when; no one knows for sure.  

Saline implants will eventually develop a small hole in the implant, and the saline will leak out of the implant.  The saline implant will "deflate", and the breast will be left with an empty bag.  The recommendation is to remove and/or replace the implant.  Saline implants typically last 10-15 years.  

Silicone implants can eventually rupture, and the silicone will leak out of the implant into the breast pocket.  A gel implant "rupture" should be corrected by removal of the implant material, and/or replacement with a new implant (often with a capsulectomy).  Silicone implants typically last longer than saline implants, maybe 20 years or more.

If you have had implants in for many years, it is typical that both have ruptured and need replacement. The "Gummies" are a type of silicone implant that has more cohesive gel.  They too can rupture and should be replaced when this happens. Some physicians like the "gummies" better than regular silicone implants; others don't.  Implant choice should be made based on the best implants for the patient undergoing surgery.  Tissue characteristics, size of implants, desired look all weigh into which implant is best for the patient.  

You need to go see your plastic surgeon ASAP.  Your overlying skin has broken down and you likely need surgical debridement to prevent loss of your implant. It is difficult to assess this with photographs alone, and should be seen in person by a Board Certified Plastic Surgeon.  Good Luck!

Congratulations on your surgery!  Your results look great at this time.  It is very common to have unevenness and swelling in the early postoperative period.  I tell my patients that final results will take 3 months or more before all of the swelling is gone.  Don't worry at this point as this is very normal.  Follow the specific instructions that your plastic surgeon has given you and make sure to keep your postoperative appointments.  Everything appears to be healing well at this early stage in your recovery.

Compression garments are an important part of the recovery process to prevent fluid accumulation under the skin and to decrease swelling within the tissue following abdominoplasty.  My patients wear compression garments for 6 weeks or longer to address these issues and also reinforce the rectus abdominus plication (muscle tightening) performed during the procedure.  Please follow your postoperative instructions given to you by your plastic surgeon.  If there is a new opening or wound since your last visit, you should contact your plastic surgeon to discuss this with him/her.  It is best to follow the specific recommendations that your surgeon gives you as each doctor may handle your situation differently.

Thank you for your question.  Based on your photographs and your symptoms, you are an ideal candidate for a breast reduction.  A breast reduction is a fantastic procedure to address most of your problems.  Please see a Board Certified Plastic Surgeon for an in person consultation to determine the best procedure for you.  Patients are extremely pleased after the procedure as it corrects many of their problems (back/neck ache, rashes, etc) and also improves the appearance of the breast.

Sorry to hear about your situation.  Based on your pictures, it is difficult to tell if you have torn a stitch or not.  Your plastic surgeon should be available to answer a question with a simple phone call even if it is the weekend.  It is very unlikely that you need any stitches at this point.  Just some simple postoperative wound care should handle it.  Please contact your plastic surgeon for his/her instructions. Good luck!