Elaina Chen, MD

Have you had lip filler as well as frown lines? Perhaps some filler in the corners of your mouth as well? It does look like migrated filler, unless that glamorous photo of you is a pre-filler picture, in which case it was already there. If that's not a pre-filler picture, one would be helpful for comparison. If that was there before your fillers, there isn't much that can be done for that. HA filler should be easy to dissolve. Other fillers (Radiesse etc) cannot be dissolved.

It's hard to tell with photographs in a bra that push your breasts together, and without a preop photograph to compare. Are your implants submuscular, subfascial, or subglandular? Some patients naturally have symmastia that is made more noticeable with breast augmentation. Without these additional pieces of information, it's difficult to give you any recommendations.

I would absolutely not do a free nipple graft. I have successfully avoided free nipple graft in patients with sternal notch to nipple distance of over 40cm.

Did your MBC have any primary tumor in the breast that required surgical excision, eg lumpectomy, followed by radiation?

If yes - breast reduction after radiation is always a bit tricky as the breast tissue and skin doesn't behave normally and can settle in unpredictable ways. I recommend finding a plastic surgeon who also specializes in oncoplastic breast reconstruction. Many plastic surgeons will be uncomfortable operating on a radiated breast.

If no - it depends on how much weight you've gained. I generally recommend that patients are at BMI less than 30 to have best surgical outcomes, especially if operating on a radiated breast.

In either case, your oncologic medications may suppress your immune system and make it unsafe to proceed with surgery. Coordination will be required between you, your oncologist, and your plastic surgeon.

It looks like your implants are still high and haven't fully dropped into position yet. Have you been doing pec stretches to encourage the muscle to soften and lengthen? I ask patients to do the "diver stretch." It might help to know if the implants are completely submuscular vs dual plane 1-3. Once the implants drop into position, it will be easier to determine how much excess breast tissue needs to be removed. To answer your question specifically, yes, your surgeon can absolutely remove the extra breast tissue during mastopexy to improve the symmetry of your breasts!