What type of revision is needed and how do I find the best surgeon for this? (Photo)

Question

My breasts were totally botched and I’m very self conscious and dysphoric about it. I desperately want to get it corrected as best as possible. But I have no clue how to proceed with this. My original surgery was in November 2023. I hate how they look now. Who would be able to fix it? I don’t know what was done wrong, but the incision placement is far above the folds, the scar is keloids, and the breast shape is so irregular.

Maryam Zamani (Saheb-Al-Zamani), MD · Answer

Hi Monet,
It appears that your breast fold has been obliterated with bottoming out/ double bubble formation of your breast implants below your original fold, likely due to overly large implants for your anatomy and aggressive dissection at the fold. The poor scarring at the site likely has both a technical component and possibly a genetic tendency to keloid/ form raised scars. A consultation is required for complete assessment and surgical planning but this deformity can possibly be corrected/ vastly improved with change of implants, reconstruction of your breast fold, and support with scaffold/ internal bra.

Maryam Zamani MD FRCSC
Double-Board Certified Plastic Surgeon

Jacob Carlson, MD · Answer

I think it would be helpful to have additional photos to provide a more in-depth answer. A picture of the your full chest would allow us to get a better idea as to the position of implants on the chest wall. And if you had a similar picture of your chest before surgery, that would also be immensely helpful.
Based on the bottom right photograph, it appears that the incision was made at the level of your inframammary fold. In your case, before surgery, the distance from the nipple to the inframammary fold was likely very short. It's hard to tell without pictures from before surgery, but you may have had some degree of tuberous breasts.
The implants are now positioned before the level of your natural inframammary fold. If you had tuberous breasts before surgery, placing the implants at that level was probably intentional and the appropriate thing to do. If you did not have tuberous breasts deformity surgery, it is possible that the implants have descended lower than your surgeon intended.
Regarding the appearance of the scar, unfortunately some people are more prone to developing hypertrophic/keloid scars. Have you had surgery anywhere else on your body? Revising the scar is a possibility, and there are techniques and medications that can be used to reduce the chance of it happening again, but there is a risk that it could recur. If the implants are lower than they need to be, it may be possible to revise the scar and conceal is somewhat underneath the crease of the breast. If the implants are in the proper position on the chest wall, it would be very difficult to conceal the scar even if it is revised. 
I would recommend discussing this further with your surgeon. If you seek a second opinion, I would recommend bringing pictures from before your surgery to that consultation?

John LoMonaco, MD, FACS · Answer

Sorry you have gone through this.  You probably have implants that have slipped below your breast fold, partially causing the irregular shape.  The heavy scar also contributes to the irregular shape.  The correction would be to place new implants (probably smaller) and reposition them in a new pocket to restore the shape as best as possible and lower the scars in a position to where they are not quite so visible.

Daniel Barrett, MD · Answer

Dear MonetSoufflet,

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

Guler Gamze Eren, MD · Answer

Thank you for your question.You had a bad experience unfortunately, you have keloid and due to highly localized incision you seem than you have bottom out deformity. I recommend you to try to find a dermatologist or plastic surgeon who is experienced in scar treatment with lasers and regenerative treatment protocols. Than you can search for breast implant revision surgery. Once you have treated the scar the breasts may look better.Best Luck

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