Matthew S. Kilgo, MD

Hello and thank you for your question. Photos taken prior to your breast augmentation would be very helpful in determining the cause of your asymmetry. Often significant asymmetry exists preoperatively, which can make it more difficult to achieve symmetry with breast implants. It does appear you have a combination of issues contributing to your asymmetry. I would agree that you do have some "bottoming out" on the right side, which can be corrected with removal of your implant and repair of the capsule. Mesh support may be indicated, particularly if you want a larger implant. The implant on the left is "high riding". Correction requires removal of the implant, release of the capsule and possible additional release of your chest muscle to allow the implant to sit in a lower position. If you had a constricted breast before the surgery, additional procedures may be necessary, including lowering of your inframammary fold on that side. If you had a wide distance between your breasts before surgery, achieving more cleavage can be difficult with implants alone. I find that this can be effectively done with fat grafting. Good luck. I hope this helps.

Hello and thank you for your question. Gynecomastia can be treated with liposuction, direct excision or a combination of the two procedures. It really depends on your physical findings. If most of the soft tissue fullness in your chest area is due to fatty tissue, then liposuction alone may suffice. Direct excision alone would be appropriate if the fullness is caused by excessive glandular breast tissue. Most cases of gynecomastia are secondary to a combination of excess glandular tissue and fatty tissue, and therefore a combination of direct excision and liposuction often gives the best results. In my practice, I typically use VASER liposuction. For best results, you should consult with a plastic surgeon certified by the American Board of Plastic Surgery.

Hello and thank you for your question. Based on the photographs provided, you have a significant amount of excess skin along your lateral torso. This can be treated by direct decision with a procedure called a belt lipectomy. However, if you have significant skin excess of the outer thighs and laxity or ptosis of the gluteal region, which is very common after weight loss, then you would benefit from a posterior body lift, which will also address those areas. Good luck. I hope this helps.

Hello and thank you for your question. The use of bio absorbable mesh in revision breast surgery depends on the quality of your soft tissue support. Structures that provide support include the breast capsule ( scar tissue around the implant) and the breast skin and subcutaneous fat. Based on your photograph, you have a " double bubble" deformity with descent of the implant below the existing inframammary fold, which is indicative of loss of structural support. Another factor that may be contributing to this would be downward pressure on the implant by your pectorals major muscle. You may benefit from changing planes to a sub glandular or sub fascial location ( if your implants are currently sub muscular) along with repair of your capsule. In these cases, I often have mesh available and make the decision on whether or not to use it based on the structural quality of the capsule during the repair. Good luck. I hope this helps.

Hello and thank you for your question. Congratulations on your weight loss! It is difficult to tell what would be the best procedure for you without a physical examination. With that much weight loss there is typically skin excess in both the horizontal and vertical dimensions. A standard tummy tuck will correct some vertical excess of the abdomen. Depending on your physical findings, a lower body lift is also a good option that results in improvement in lower back/gluteal and lateral thigh skin excess. That procedure also tends to correct more of the vertical skin redundancy of the abdomen by pulling laterally. However, a fleur-de-lis may be the only option if the vertical skin redundancy of the abdomen is excessive. Importantly, you should pursue your procedure only after you've reached a stable weight. You should also consult a plastic surgeon certified by the American Board of Plastic Surgery for best results. Good luck. I hope this helps.