Joseph Zakhary, MD

With time implant position can change from the initial surgery. With larger implants (~500 cc plus) you may notice a loss of upper pole projection and and increased nipple to fold distance from the implant weight stretching the skin of the lower pole. Also the implants will lateralize when you lay down and over time create a space to fall into. While revision is possible and will require tightening of the internal pocket (capsule) to avoid the implant migrating laterally, something for support should be considered, as well, such as galaflex or adm. Now if you would consider a smaller implant placement it would lead to likely more longevity of your augmentation as the weight of the implant would be decreased. Relative cost for revisionary surgery varies by surgeon, location, support structure but ballpark surgeons fee could range from 6-15k depending on location but you would still account for facility, anesthesia, implants, gala flex etc. depending on how you decided to proceed.

Combining an augmentation and mastopexy has roughly a ~20% percent revision rate. So about 1 in 5 patients will get that second procedure regardless. Patients who benefit from augmentation and mastopexy either as one surgery or two typically have a nipple to fold distance of 10 cm or greater as an implant alone does not typically give the desired result. Obviously not all implants are the same as a small implant and a larger implant will give an overall different appearance and fill the breast differently. More specifically to the picture you provided for the right side an implant alone would be sufficient but to achieve symmetry the left side would most likely benefit from an implant as well as a mastopexy for symmetry and I would recommend that at the initial surgery.

I believe in silicone implants as they continue to improve with each generation and have less rippling, however its preference as it is a more expensive device, and saline would be acceptable given the amount of breast tissue you have too camouflage the implant.

Hello,

There are several components to be addressed when removing implants and predicting the postoperative appearance. The first is the current size of the implants. The second is desired goals of postoperative appearance. The third is how much of the breast is actual breast tissue versus implant.

In short when you remove an implant several things happen, you lose upper pole fullness that the implant provides, but you also develop ptosis from the now deflated breast appearance. I traditionally do a mastopexy at the time of explantation to address the immediate ptosis and new nipple position. If there is significant breast tissue remaining this usually gives a great result, but sometimes fat grafting to the upper pole will help address the loss of upper pole fullness that removal of a large implant creates.

Hello,

Areolar reduction surgery is a safe and effective procedure and the risk of infection is less than 1%. After the first week the risk of infection decreases even further. If there is a permanent suture left in place to control the size of the areola there is always a risk of having an infection related to this foreign material but that risk is low. Diabetes, Nicotine products, steroids etc increase the risk of infection with any surgery.

Hello,

I currently advise all my patients to get the vaccine if offered regardless of proximity to there surgery for the first dose. For the second dose I tell patients if it is possible to schedule it so that they don't get it within 48 hours of their that would be advisable only because it can cause some headache and fatigue around 12-24 hours, but it is not an absolute contraindication within that window. Hope this is helpful.