Jean-Pierre Riou, MD

Thank you fo your question Verona. It is very unlikely for an Augmentation to cause symmastia. I have been specializing in Breast Surgery for 25 years and have placed over 8,000 implants. I have caused symmastia twice in my career, both cases were broad women that were very flat and emphasized the desire for close cleavage preoperatively. The implants I had chosen were wide to accommodate for their large base diameter, and their inner pocket were over-dissected. I corrected both with sutures successfully. I have worked on many others that where not my patients, most with sutures alone, a few with ADM grafts. I would recommend getting your implants behind the muscle and making sure your surgeon leaves the sternal head of the pectoralis major muscle attached to the sternum, which acts as a barrier preventing the two implants pockets from communicating. I have never, and absolutely do not recommend, suturing the medial pocket at the time of the primary Augmentation. The key to symmastia, as I have learned from my own mistakes, is to prevent it in the first place. Fat Grafting would not be appropriate in this setting either. Good luck Verona, make sure you get several opinions from board certified plastic surgeons (ABPS) that have large experience in breast surgery specifically.

JP Riou, MD, FACS

Yale trained, board-certified Plastic Surgeon

25 years experience specializing exclusively in Breast Surgery

Thanks for the question Donna. Your distress is not unusual. There is frequently a dip in mood post-operatively for a few weeks. Don't rush to judgement on the size of the breast this early, there is still significant swelling 17 days out. That being said, if the size is still too big at 6 month you can get a Downsize, but would likely need a more aggressive lift (Circumvertical or Inverted-T) to manage the extra skin from child-bearing. Good Luck.

JP Riou, MD FACS

Yale Trained Board Certified Plastic Surgeon

Specializing in Breast Surgery for 25 years

Thanks for your question Jacqueline. The photos are very helpful: They show that you are very fit with low body fat, mild scoliosis (right shoulder higher), mild breast asymmetry but similar low volume, and bilateral Grade 2 ptosis (droop) R>L . You are likely to get significant improvement with implant alone, as long as it is a Dual Plane technique. You will still have a slightly lower than normal nipple position, but with time as the lower pole expands the breast will look less droopy and the volume will be restored. In my experience the Grade 0 & 1 do very well without a lift, the Grade 3 always need a lift, and the Grade 2 vary depending on the patients expectations. When patients similar to your case come in hesitant about the scars from the lift, I will recommend Implant alone, counsel them to be patient the first several months, and explain that it may be necessary to do a limited scar lift down the line (no sooner than 6-12 months) if they want a higher nipple position (most are happy with a slightly low nipple position and "natural look" and don't proceed withe the lift)

JP Riou MD FACS

Yale-Trained, Board-certified Plastic Surgeon

25 Years experience exclusively in Breast Surgery

Over 8,000 Implants used

So sorry you are distressed about your appearance. As surgeons it is the last thing we want for our patients. You are extremely early in your wound healing process and from the photo all looks as expected at this time 3 weeks post op. It is too early to judge volume or symmetry, so don't get too focussed on that at this time. You had one of the most complex breast surgery performed: Glandular resection, Implant augmentation and skin tightening. That is remodeling at 3 different levels, and it is rare to get perfect symmetry no matter how well the surgery has been executed. It is important to set a realistic expectation before the surgery. In addition, no matter what aesthetic surgery is performed, most patients experience some degree of an emotional roller-coster postoperatively. Often the "blues" the first couple of weeks, with self doubt about having done the surgery, tearfulness when the often deformed, swollen breast and irregular incisions early postop  does not meet their preop image of what they were expecting. The good news is that by 6-8 weeks, the low mood often gets replaced by elation as the swelling subsides. Make an appointment with your surgeon to get some reassurance. Be patient, unless there are serious complications (Which does not appear to be the case here) revision should not be attempted until a year later. To do so can lead to a worsening situation.

JP Riou, MD FACS

Yale-Trained Board Certified Plastic Surgeon

Specializing in Breast Surgery for 25 Years

Thank you for sharing your photos, they were very helpful. You are a good candidate for a Mommy Makeover baring any health issues. The TT part is straight forward and you can expect dramatic improvement: most of the skin from your belly button to the pubis would be resected, the diastasis recti (muscle looseness) would be repaired and liposuction would be done for contour improvement. 

The breasts need a lift, with or without an implant depending on your desired size in the end. I'm guessing you're a C cup and if the size is ok now in a bra, you might forego the implants otherwise be conservative in the volume if you chose to have them as the extra weight can deteriorate the lifted look over time.

As for the BBL, It's hard to tell without those specific views. Be careful if you chose to do it. I would consider staging the procedures, the complication rates for BBL are some of the highest of all the procedures we do, including fatal fat emboli.

Your recovery will be difficult, do not underestimate the soreness. Take plenty of time off to recover and rest. I disagree with some of the other surgeons that say a TT is less sore than C-sec. In 25 years of doing this work patients usually report the reverse.

Best of luck,

JP Riou, MD FACS

Yale-Trained Board Certified Plastic Surgeon