Revision breast lift, capsular contraction, snoopy deformity, 360cc - how should I proceed? (Photo)

Dear Smilealifetime,

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.
If you are considering breast surgery revision, you should speak with a board certified plastic surgeon and have yourself properly assessed. Only after a thorough examination you will get more information and recommendations. Also, you have to make sure that your surgeon understands your breast augmentation goals.


Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Hello and thanks for sharing your history and photo. A high position two years after augmentation is almost always a pocket and envelope issue rather than muscle strength alone. A tight lower pole, a high inframammary fold, limited inferior release or the way the capsule formed can keep the implant riding high. Strong pectoral tone can contribute yet it is rarely the sole driver.
Why the lift did not solve itA lift repositions the nipple and skin. It does not move a high implant. If the pocket still holds the implant up the breast tissue can settle over it and you see the same top heavy shape again. That is the classic snoopy or waterfall pattern.
What an effective revision focuses on• Pocket reshaping. Lower the fold in a controlled way if it sits high. Perform precise capsulotomies or limited capsulectomy so the implant can occupy the lower pole• Plane choice. Stay dual plane with targeted muscle release if animation or tightness distorts shape. With very thin tissues consider subfascial or prepectoral only if pinch thickness is adequate and with internal support when needed• Internal support. Capsulorrhaphy, strong internal sutures or mesh can stabilize the new fold and keep the implant from riding high again• Capsule management. With a textured anatomic implant and recurrent contracture discuss total capsulectomy and sending capsule for pathology as appropriate
About going to a 360 cc high profile subglandular to fill the bottom• Subglandular in a breast with near zero native tissue risks visible rippling, palpability and bottoming out unless support is added• A higher profile increases forward projection by about 0.8 cm in the numbers you quoted. That may read larger in clothes even if the footprint is similar• Cleavage is set by sternum width, medial soft tissue and the medial pocket. Size escalation alone does not close a wide gap. Safe medial release with disciplined control is what narrows the space, and over release risks symmastia
You want to downsize. What that usually requires• Downsizing into a stretched envelope needs a lift pattern that truly tightens the lower pole. Periareolar alone is often not enough and can widen the areola with time• A vertical or Wise pattern can be the tool that lets you use a smaller implant without a long lower pole that looks bottom heavy• Auto augmentation techniques can repurpose lower pole tissue to build upper fullness so the implant can be more moderate
Brand and gel choices• Motiva can feel soft yet it is not a solution to capsule or pocket mechanics• Choose implant base width and cohesivity to match your footprint and support plan, not brand marketing• Many revision surgeons favor smooth round devices to avoid rotation issues seen with anatomic shapes
What to clarify before saying yes• Primary cause of the high position on each side and the exact new fold height planned• Capsule plan. Capsulotomy versus partial or total capsulectomy with pathology when indicated• Final plane and whether internal support will be used• How medial pocket will be controlled to seek more cleavage without risking symmastia• Whether intraoperative sizers will be used to confirm symmetry and cleavage before closure• Realistic volume range that meets your wish to look smaller yet balanced
Bottom lineA well planned pocket revision with proper support is what fixes a high implant and snoopy, not simply a bigger or higher profile device. If the goal is to look smaller and more lifted expect to pair implant exchange with a lift pattern that tightens the envelope. That is how you avoid a larger look while gaining shape.
If you would like a more specific opinion for your case standardized photos and any prior operative notes can be reviewed in a short complimentary conversation with a coordinator so your plan addresses the exact mechanics before any medical evaluation.
Wishing you a clear plan, steady healing and a result that feels balanced and comfortable.Güray Yeşiladalı, MD