I had a mastopexy with breast implants 6 months ago and now the skin has loosened. Do I Need Another Breast Lift?

I had a mastopexy with breast implants 6 months ago. Since they have settled it seems like a little more skin needs to be removed. The upper pole skin is loosened and some stretch marks that I had have now reappeared although not quite as before. I have a moderate profile implant and wonder should if I do a secondary mastopexy should I use a moderate plus profile to obtain more projection and ensure greater upper pole satisfaction as well as stave off another future mastopexy.

Doctor Answers 8

Not unusual to reoperative to provide further tightening after breast lift

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Yes, the moderate-plus profile gives a little more projection.  But the main issue is probably the tightness of your mastopexy.  I wonder what type you had because some (the periareolar technique) do not adequately tighten the lower poles where the excess skin is located.  Even the best techniques (vertical) can show some signs of loosening with time.  I have revised my own vertical breast lifts on many occasions to provide more tightening.  The good news is that this involves no new scars and the recovery tends to be easy.  The vertical lift facilitates this (examples attached).  The inverted-T produces a long horizontal scar and the breast shape does not tend to be as conical, which is why many of us no longer use this approach.

Kansas City Plastic Surgeon
4.7 out of 5 stars 62 reviews

Breast Augmentation/Breast Lifting Revision Needed?

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Even though you are 6 months of surgery,  and may be in your best interest to wait even longer before putting yourself through more surgery. Assuming you are working with a well experienced board-certified plastic surgeon he/she will be in the best position to guide you based on your physical examination at that time and after a thorough discussion of your goals. In my practice, I prefer the use of "goal pictures” for this communication.   Depending on your goals, adjustment of breast implant size/model and/or further skin excision may be indicated.

Best wishes.

Improvement in Breast Shape after Surgery

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Hi there-

I would first echo my colleagues- it would be very difficult to answer your questions without a formal exam...

In general, however, it is sometimes the case that women who have stretch marks on their breasts (which, of course indicate that the skin is of poor quality and has little remaining elasticity) end up less than completely pleased with the results of breast surgery, even if the immediate results were quite pleasing to them.

In these cases, this deterioration in the appearance is entirely due to the poor quality of the remaining breast skin- and has little to do with an ongoing excess quantity of skin.

It is possible that further skin tightening through revision of your breast lift and/or placement of a different implant may help to camouflage this problem, but the fundamental problem remains- the skin quality is poor.

In my practice, we have had some success in restoring lost skin quality in cases like this through a very regimented and specific laser treatment protocol which we are hoping to publish soon.

Ask your Board Certified Plastic Surgeon if they may offer a similar option.

Redo mastopexy

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A mastopexy is performed to remove excess skin, lift the nipple and areola and remodel the gland. If there is not alot of breast tissue, then an implant may be necessary. As for a redo, it would be difficult to tell without examining you.  Stretch marks will not go away with a lift unless they are within the pattern of skin excision.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Mastopexy re-do? When it may help.

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Mastopexy is done to excise excessive skin.  In most individuals their skin excess worsens after pregnancy due to the enlargement & deflation following the hormone related engorgement which affects the elasticity of the skin.  Some younger people have mastopexy to improve the appearance of the breast due to elongated breast or enlarged areolas.  In these individuals the elasticity of the breast iskin s not necessarily impaired.  The only way to determine if another mastopexy is necessary is to have an evaluation so that the skin elasticity and excess can be quantified.  

In general, implants do not lift the breast and very rarely will a periarolar lift tighten the breast envelope adequately.  The vertical mastopexy also will tighten the envelope but does not reshape the breast in a way to keep the nipple up.  If one has undergone the standard "wise Patterned" breast lift, it is unusual to have much excess skin and the shape of the breast is round and attractive.    With this technique there can be "bottoming out" where the fullness of the  implant and breast tissue falls too low below the areola. This can be treated with excision of an ellipse under the breast rather than full redo mastopexy.  

My recommendation is to be seen / provide photos so that proper evaluation can determine the best option to achieve the results you are looking for.  Beware that doctors who do not do the standard wise pattern lift will not have the confidence in the outcome and will believe the scars are too much but the patient's who undergo this technique are uniformly happy as the breast are up where they want, the skin is taught, the areola is small and the breast is attractive- sunny side up, just like the cute breasts of a young woman. 

Kimberley Lloyd O'Sullivan, MD
Providence Plastic Surgeon

Another breast lift or larger implants

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Any kind of breast surgery using implants will typically initially result in the implants being a little high. As the recovery process continues the implants settle down into a better position. The tightness of the initial mastopexy result also softens. In most cases (and I can't speak to your case specifically) stretch marks are improved but do not go away. There really is no way to keep the very tight appearance of the early result as this is due to swelling that eventually resolves.

I don't recommend putting in a larger implant unless you want larger breasts. The shape of the implant can influence the appearance so if you want more upper pole fullness you might want to use higher profile implants (such as moderate plus if you have moderate now). Allergan moderate profile implants have a higher profile than the moderate plus from mentor for the same volume so you might want to consider those as well. However, if you feel the breasts are still a bit too loose or sagging, placing a higher profile implant (or even a larger one) will not stave off the need for a revision of the mastopexy. If you have excess skin it will need to be removed and tightened for the best result.

I hope this info helps!

Adam Rubinstein, MD
Miami Plastic Surgeon
4.9 out of 5 stars 21 reviews

Another breast lift

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No photos very hard to answer. First I recommend HIGH PROFILE implants. Second get another in person opinion. This should help you understand the issues better.


Breast lift and implants

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This is the real issue with breast lifts and breast augmentation: the implants want to weigh your skin down while the lift is meant to bring them up.  Everyone has some skin stretch, and it's impossible to predict exactly how much any given patient will have after surgery.  I would suggest waiting until you are a year out from surgery, and then reassessing everything with your surgeon.  The problem is that another lift may leave you back where you started, whether you change your implants or not, so you'll eventually have to decide if that risk is worth it to you.  Best wishes and good luck, /nsn.

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