What to Do with Bad Results from Breast Implants?

I am a year and a half years post-op. I recently went to my surgeon and found out that my implants have bottomed out. My scars are keloided and about 2 inches above the crease. I have no cleavage. My boobs are extremely far out to each side. He seemed very unhelpful and basically offered to charge me full price to do it again. My question is that fair? Are these flaws from a bad procedure? What do I need to do?

Doctor Answers 19

Breast Augmentation Revision

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Sorry to hear about your problem.

Implant malpositioning can be from many different factors and at 1.5 years after surgery it may be unrelated to surgical technique. You will likely need a revision that involves re-creating the bottom portion of the implant pocket using suture techniques. It may also require revision of your scar and post-operative treatments to decrease the chance of hypertrophied or keloided (there are significant differences) scars recurring.

In my San Francisco area practice our breast augmentation revisions (including all costs) usually start around $5000 but can quickly increase in price depending on the complexity of the problem and the desires and needs of our patients.

I hope this helps.

Unfortunately, you will probably have to pay for a revision

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To andfran85,

Hi! Your bad result may or may not have been preventable. Sometimes it is hard to tell even after doctors have examined the patient. But the point is, it is now largely irrelevant.

1) What I do if I think a patient of mine will benefit by a touch up, is I urge them to have the revision within a few months. We don't charge for any revision done one year from the original procedure or less. But if it is more than one year, then we charge (and sometimes we make exeptions if there are extenuating circumstances).

Now that's my policy. Every plastic surgeon has his own policy. I know it seems unfair, but there is no law that says your surgeon has to reoperate on you for free.

2) Would you WANT to go back to the same surgeon if you have such a bad result? If he or she is not taking any responsibility, then there may be a bad attitude. I know it is a lot of money, but you may be better off going elsewhere.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Revision breast surgery

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The key to your successful reoperation will be coming up with a plan for avoiding what happened the first time.

Bottoming out of the breasts can be a naturally occurring problem, especially with larger implants. The problem tends to be more prevalent in patients with prominent breast plate bone (pectus carinatum) or with athletic patients. Also, because the implants should be centered on the nipple, not all patients will get the same cleavage from their surgery without resorting to an inordinately large implant.

You are best consulting with a board certified plastic surgeon with considerable experience and interest in revision breast surgery, as revision surgery is much more complex than primary surgery. Revision surgery has additional concerns with circulation, pockets, breast position, etc.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 194 reviews

It sounds like you will need a revision

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Unfortunately, it sounds like you will need a formal revision procedure. It's difficult to know exactly what that will entail without examining you, but given your description, things will not improve without surgery.

I think that if you are unhappy with your surgeon in any way, you should seek out another Board-Certified Plastic Surgeon in your area for the procedure. Remember, any revision surgery is always more difficult than the original, so it's important to find someone with the experience and judgment to take on your case. It will likely involve another full fee, but it may be worth it in the long run given the situation.

Good luck,
Dr. S

Shahram Salemy, MD, FACS
Seattle Plastic Surgeon
4.9 out of 5 stars 155 reviews

Discuss your concerns with your plastic surgeon

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I am so sorry to hear about the difficulties you are having with following your breast augmentation procedure. All the problems that you are experiencing are known potential complications of breast augmentation. Communication is essential. I would advise that you return to your plastic surgeon. Be pleasant but frank with your concerns and let he/she know your position on each. If you remain dissatisfied, then I would seek another opinion. I realize that this is a difficult position to be in.

I hope this helps!

Stephen A. Goldstein, MD
Englewood Plastic Surgeon

Review secondary procedure policies of your doctor

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I sympathize with you, this is not a happy situation. Unfortunately, sometimes a less than good result occurs in surgery. If a bad result happens, it is really up to the surgeon how he will handle the complication/unfavorable result. It may be helpful to review the policies of the doctor regarding secondary procedures- they should have been clear and in writing before you signed on the dotted line.

Having said that, my philosophy is that if a bad result occurs and the patient was compliant and a good patient, I will bend over backward to make things right. If this requires a trip to the OR, that will be up to the patient to pay (I don't have my on OR with general anesthesia capability), but I won't charge for what I do. I always want a happy patient!

It is very difficult in retrospect, and without benefit of exam to determine if your outcome is due to poor technique, or the way you healed, or a combination. It does seem like you have some wound healing problems (keloids).

It is obvious at this time that you are more or less looking at the final result, and to get an improvement, you will be facing additional surgery. Since the surgeon is unwilling to give you financial consideration, you need to decide if he should do it. One thing you should understand going into the next operation however is that it will be much more complex, and likely more expensive. You want to pick your surgeon carefully.

I am very sorry about how things turned out for you, it is not fair. If you would like to drive to the DFW area, I would offer to examine you at no charge and render my opinion as to what your options are.

Best to Consult with a Board Certified Plastic Surgery About Your Options

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Typically, it's best to wait 6 to 12 months depending on the reason for #revision.  Matters such as sagging or drooping  and size change will not improve with time. As with all cosmetic surgery, results will be rewarding if expectations are realistic. With any surgical procedure, there are some risks which your doctor will discuss with you during your consultation. It's best to consult with a board-certified plastic surgeons who have specialized in breast surgery and cosmetic surgery are suitable to perform your breast augmentation. You will then greatly improve your chances of getting the result you desire, and, without the need for a revision surgery. Aside from checking board-certification, it is suggested that you look at before and after photos of the surgeons actual patients, and read patient reviews. Gathering all of this information will help you make a well-informed decision. Please be advised that each patient is unique and previous results are not a guarantee for individual outcomes. 

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 116 reviews

What to Do with Bad Results from Breast Implants?

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From your question, it certainly seems that you were unhappy with the current presentation of your breasts. Unfortunately, without a formal exam, it is impossible to suggest what you may the best suited for in terms of revision. On the other hand, it seems to suggest that you will need a fair amount of revision work in order to work towards achieving your goals. I strongly suggest that you go see a board-certified plastic surgeon.

Bad results from a breat augmentation are uncommon but the surgeon should fix them for free.

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Presuming what you report is true, it sounds like a revision might be in order.  The surgeon is not responsible for a keloid if that's what you have but if the implants reside on your chest wall in the wrong position, they should be moved.  I personally do charge patients additional professional fees for revisions.

What to do? Get more advice, compare options

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Andfran85: I'm sorry to hear you are having such trouble. Surgeons work to produce consistently good results for all patients. But not all patients achieve these results. Now you need to search for a solution. You might not get the final appearance you seek, even with more surgery, so plan carefully.

You first sought the recommendations of your original surgeon. That was good. As a surgeon, I can tell you that keloid scars are not likely caused by the surgeon, but your body's healing. Bottoming-out, lateral displacement, lack of cleavage, and scars rising above the crease may all be related to lax tissues rather than your surgeon's work.

In your situation, your next step may be to seek the advice of one or more experienced, board-certified plastic surgeons. An in-person evaluation and exam is necessary to properly counsel you. Options for additional surgery may include internal support suturing, smaller implants, breast lift, etc.

After learning more from other sources you'll be in a better position to choose.

Sutton Graham II, MD
Greenville Plastic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.