Daniel Reichner, MD, FACS

Ekaterina In your situation, I highly recommend considering a vertical mastopexy, commonly known as the lollipop technique. This approach allows us to create smaller areolas with minimal scarring. I prefer this method over the Benelli technique because it avoids puckering, nipple distortion, and undesirable scars that can sometimes occur with other surgeons. Particularly for cases with larger, puffy areolas and grade II or III nipple ptosis, the vertical mastopexy can yield excellent results with reduced scarring and improved nipple positioning.

Cheerful Based on the photos you have provided, a breast lift, also known as mastopexy will be recommended by most board-certified plastic surgeons. This procedure is required to raise,reshape and tighten sagging breasts - to create a more youthful and lifted appearance. I offer a specialized breast lift technique that not only lifts the breasts but also redistributes volume to the upper pole, resulting in a more augmented and sculpted appearance. The procedure involves removing excess fat and breast tissue from the lower breast and then using micro fat grafting to enhance the upper breast, creating increased cleavage and upper pole fullness. This approach is more durable compared to traditional skin removal/tightening methods, which may stretch out over time. Additionally, I reinforce the area under the most tension by overlapping the dermal collagen in the inferior breast. There are optional techniques that I offer my patients to enhance breast shape/firmness and increase upper pole volume and longevity. One such method involves incorporating a small implant, not to increase breast size but to enhance breast shape. The small implant is positioned near the upper breast pole and this can improve the breast shape and firmness. The mastopexy is then performed to reduce and lift the nipple-areola, reduce lower pole volume and tighten the skin. Another approach involves using Galaflex Mesh, a knitted surgical implant, to provide extra support during a breast lift. This FDA-approved implant is made of a biocompatible material that the body eventually safely resorbs. The mesh is placed internally to reinforce the breast structure, helping to maintain the lifted position and enhancing the longevity of the results. Ultimately, the goal of my breast lift is to provide the patient with improved breast aesthetics and confidence, addressing the sagging concerns and achieving a more youthful appearance. I tailor the procedure to the patient's specific needs and preferences, ensuring a successful outcome.

As a plastic surgeon, it's essential to have an open and honest conversation with patients regarding there concerns. Firstly, breast sagging a year after breast augmentation can be influenced by various factors, such as your weight loss, your breast and nipple ptosis (droopiness) before surgery and the technical aspects of your sub-fascial implant placement. It's also important to understand the other specifics of your case, including your age, skin elasticity, and breast tissue characteristics, to determine the best approach. Based on the photos you have provided, a breast lift, also known as mastopexy will be recommended by most board-certified plastic surgeons. This procedure is required to raise and reshape sagging breasts - to create a more youthful and lifted appearance. This procedure is appropriate and maybe necessary for patients who have experienced breast sagging, especially after having large breast implants. While scars are inevitable with a breast lift, they typically fade over time and become less noticeable. It's essential for you to have a thorough discussion with a board-certified plastic surgeon about your concerns regarding scars, so the surgeon can explain the expected results and their specific surgical techniques and after-care steps that can be taken to minimize scarring. One other important option to address regarding your problem is the addition of an Autologous Dermal Matrix (ADM) as an “internal bra” to support larger breast implants (that are known to accelerate breast and nipple ptosis or “sagging”). ADM is a biological material that can provide additional structural support to the breasts, potentially helping to improve the shape and reduce sagging over time. This procedure might be suitable for some patients, but individual considerations must be made - the plastic surgeon’s experience with this material and the extra cost. ADM can cost as much as two breast implants. It is important to emphasize that a thorough consultation with a board-certified plastic surgeon (drreichner.com) is essential to assess your unique situation accurately. We have the expertise in handling cases like yours and can provide personalized recommendations based on your needs and goals.

Louise, it's crucial to determine the duration since your surgery as it provides valuable insight into your healing progress. Nonetheless, I'm concerned about the possibility of capsular contractions with your implants, evident from their high and firm position, accompanied by puckering around the incisions. Additionally, the presence of drainage indicates a potential low-grade infection that requires prompt attention and needs to be addressed.

Excellent question! Choosing the right implant size is a critical decision when opting for breast augmentation. I always advise my patients not to solely rely on their plastic surgeon to determine the ideal size. Breast size and body proportions can vary significantly among individuals, depending on their unique body image. Several important factors come into play when deciding on the size of breast implants, such as height and weight, chest size, breast asymmetry, and the quality/thickness of both the skin and breast tissue. Considering these factors will help ensure the best possible outcome for each individual patient.

Hello Amy, The causes of these capsular contractions are likely multifactorial and also linked to chronic inflammation. Numerous studies suggest that specific common bacteria tend to form a biofilm on the implant's surface, playing a significant role in the process. Additionally, the surface topology or texture of the implant appears to be a crucial factor influencing the formation and growth patterns of these bacteria. That's why I prefer using implants with a smooth surface, as it may help mitigate these issues.

Hello Ally, considering the information you've shared, my recommendation would be for you to schedule a breast examination with a board-certified plastic surgeon. This examination will help determine if there are any physical reasons behind the pain you are experiencing. Several factors could be causing the breast pain 7 months after a breast augmentation, such as capsular contractions, implant bottoming out, or implant malposition. It's essential to get a professional evaluation to address the issue appropriately.

It is very difficult to give you any specifics without photographs.In general soft tissue infections are rare after rhinoplasty.Sutures can sometimes cause irritation - so it is best that you see your plastic surgeon so he/she can evaluation your condition.

It would be very helpful if you provided a more detailed description and some before and after photographs of your eyes. What does you plastic surgeon say?

Before and after photographs would be very helpful to assess the degree of residual swelling.  That being said, based on everything that was done during your rhinoplasty it would not be unusual to have upper lip swelling at five weeks.