Before & after - what type of surgeon do I need to be looking at to fix this? (Photos)

Considering the asymmetry you've shown in your preoperative photos, you have come a long ways following your first operation. In complex cases like this it is not unusual to require a revision. Many options may be available, but to select the best one would require an examination of your breasts. At this time, the best person for this is probably your current surgeon. The early post op photo shows that the appearance was actually quite good before things later settled. These later changes are not always predictable or controllable and are not necessarily a reflection on the competence of your surgeon.

When looking for someone to provide plastic surgery.....I would always recommend finding a surgeon certified by the American Board of Plastic Surgery. I would also recommend seeing someone with experience in aesthetic breast surgery; this includes ideally a surgeon who has completed an aesthetic fellowship accredited by the Aesthetic Society. I would continue to wait until you are at least 1 year from the initial surgery. I think the result is quite reasonable overall, especially if the implant is in a subglandular/subfascial position. Without more information regarding the surgery and physical exam, it is challenging to make official recommendations/provide any advice over this platform.

Although I mentioned changing implant profile, I realize that was not important to your issues and made things confusing. There are only two things to manage: implant pocket and the soft tissue envelope; that's all there is to affecting change to a breast. I do not remember your specific issues, but the last photo taken of you healed in the frontal position shows some asymmetrical drop out of your implants and asymmetry to the soft tissue envelope (the breast lift). How this would be managed would include re-establishing the best implant position, which would include pocket closure (capsulorrhaphy with or without mesh), and some form of lift revision. Exactly what kind of a revision lift would be required cannot be detailed by photos alone, and would require a consultation in person. Although virtual consultations are convenient for out of state patients, there is a loss of understanding by photo or video that can only be captured by physical examination.

Thank you for your question. A large portion of my practice is dedicated to revision breast surgery. I have been in practice over 28 years. It appears that your implants most likely are on top of the muscle and you have a typical "slide down" appearance. The best fix would be to place the implants back under the muscle and revise the mastopexy/lift. You should be able to have an excellent outcome. Best wishes to you.

Your breast lift was inadequate. As you can see pre-operatively, your skin envelope was inadequate to hold up the breast tissue. The added weight of the implants did not help the situation. Also, at the time of surgery, they most likely cut the supporting ligaments. At this time, I recommend explantation and lift using The Bellesoma Method. The implants are removed, your breast tissue is reshaped creating upper pole fullness, elevated higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained if not injured during your previous surgery. Later, fat transfers or small implants can be placed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

This is a common problem with breast lifts so surgeons who do a lot of lifts are used to dealing with it. Some will use mesh, others would tighten the lower portion of the breast. You need to go on a few consults. However I can tell that your original surgeon knows what they’re doing so get their suggestion as well

The most important information required to answer your question is, "What do you want fixed?" What do you want the breasts to look like that they now do not have? They're more symmetric in size and position than before, in exchange for your scars which should fade over time. Only a specific explanation of how you want the breasts changed will produce consistent and useful answers.

You are bottoming out some from the weight of your implant. I would suggest going somewhat smaller so it is less heavy and repositioning your inferior pocket. You might need mesh. Also, I am not a fan of the gummy implants since they are hard and recommend something softer.

I am sorry that your results are less than optimal. The treatment will require pocket revision and fat grafting at the same time. The use of implants and lift in the case of uneven breast very hard and I offer my patients two stage surgery. I would do lift and fat grafting first and then implants at the second stage.

Dear lyssa.angel,
You've posted a great series of before and after photos. The operative plan looks like it was solid and your early postop results were good...until your implants bottomed out. The missing information here is whether your implants are above or below your muscle, and I'm going to guess above. This information would significantly affect the revision plan. So the things you mention are all in play, except changing from saline and back to silicone makes no sense to me. You should return to your operating surgeon with your concerns for an examination and discussion of your results and revision options. Good luck!