What to do if doctor refuses to revise as I can't afford more surgeon fees? (Photos)

It is unclear whether you still have implants.  But your lift looks excellent.  You can always add an implant for upper fullness.  I also would advise against very large implants.  If a surgeon is not comfortable doing a procedure she has every right to refuse and you have the right to go elsewhere.

Based upon your description and photos, I believe you have a pretty nice result with respect to your mastopexy.  You may benefit from larger (and/or wider) implants with possible pocket revision to achieve your goals of upper breast fullness.  If your surgeon is not comfortable, it is certainly within their right to decline to do any operation they are not comfortable with.  However, it is also within your right to seek additional opinions.  I am fairly sure your result can be modified to achieve your stated goals.  

Dear samano060708,
breast revision surgery is the most difficult plastic surgery procedure performed. Botched breast surgery alters normal tissue planes and laxity, the ability of breasts to heal properly, and leaves scar tissue that dramatically affects the level of difficulty of the corrective surgery.Many patients come in to correct poor outcomes from their initial surgeries. The most common problems are due to implant malposition, bottoming out of the implant, poor scarring, and incorrect implant size.While the type of revision required will depend on the result of the previous surgery and the desired result of the patient, some revisions involve extensive pocket repair that may or may not need specialized external bras.
Every surgeon has a revision policy. Many involve reduced or even no fees for the surgeon (depending on the situation) while the patient may still be responsible for facility (the use of the operating room, staff, and supplies) and anesthesia fees. Best to go back to your surgeon and have a talk about your concerns again. Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Hi,
I think you have a reasonable result albeit you have a degree of asymmetry and your right breast looks like it could benefit from tightening (below). You already have very large implants and going larger makes no sense as it will just cause trouble for you in the long run. Most surgeons have a policy of not changing implant size which is why we involve our patients in implant selection size before hand.
You could try asking your surgeon if they would be willing to improve the asymmetry. You breasts are naturally going to fall to the sides due to the weight of the implants.
It may be worth seeking an opinion from someone else to see what they think.
Good luck.

Breast skin that sags and needs to be lifted illustrates that your tissues have natural laxity. The weight of your implants are making them drop on your chest. Does it make sense to add more weight with a bigger implant ?  The pocket that holds the implant needs to be enforced and I usually use a mesh.  (Galaflex a new addition to our surgery tools) A revision of the lift will be needed to correct the nipple areola position and may involve an incision along the crease of the breast. Surgery is not predictable otherwise there would be no problems ever. Your concerns can be addressed with additional surgery however there is additional cost and again results cannot be guaranteed. 

and we all have published revision policies.  You can certainly benefit from a revision to improve symmetry of your size and level of your areola, in addition to shoring up the lateral pocket to minimize laterailzation that you describe.  But the latter procedure is not predictable and I require my patients to wear an underwire bra 24/7 for 6-8 weeks post-op.  I agree that you should not go larger but also disagree with your surgeon in that you have other viable options to get a better outcome.  My MWL patients are clearly told they should expect a revision and they know my policy, which is rather generous when you know you're coming back someday in the future.

I am sorry to hear about your concerns after breast augmentation/lifting surgery. Based on your description and photographs, I think you will benefit from revisionary breast surgery which will likely involve adjustment of breast implant capsules, possibly revision of the breast lifting procedure, and the use of larger breast implants (if necessary to achieve size goals and more upper pole volume).   A well planned and executed procedure should serve to improve breast implant positioning, improve overall breast symmetry, and achieve size/fullness goals to a greater degree. This type of revisionary breast procedure is not unusual after initial breast augmentation/lifting surgery and the outcome does not necessarily "look ridiculous". Generally speaking, In cases where an unfavorable outcomes are present it is best for patients to discuss their concerns in a calm/constructive fashion; most plastic surgeons very much want their patients to be pleased and will do everything they can to improve outcomes.  On the other hand, an accusatory stance taken by a patient does not end up working out well for anybody involved.  For example, I would suggest avoiding using inflammatory terms... Overall, staying emotionally even keel tends to be helpful in these cases.Policy regarding coverage of expenses for revisionary surgery will vary from office to office and probably on a case-by-case basis as well. Costs of revisionary surgery may range from zero, to anesthesia/surgery center fees, to discounted surgeon's fees.  I can tell you personally that I am much more likely to waive fees for patients who demonstrate an understanding of the circumstances as opposed to patients who expect "perfection" and approach the complication in an accusatory or faultfinding fashion.
 
 In other words, I suggest patients communicate their concerns in a calm and constructive fashion; this form communication tends to be much more effective than confrontational communication.  Again, keep in mind, that no plastic surgeon is perfect and that sometimes more than one operation is necessary to achieve an outcome the patient is pleased with ( especially true for the breast augmentation/lifting procedure).
Best wishes; hopefully through courteous/respectful communication you and your plastic surgeon will be able to work out a plan to achieve your goals.   If not, your only option will be saving up for a revisionary breast procedure and seeking consultation with other well experienced board-certified plastic surgeons.