I Had a Breast Lift and my Breast is Falling Again :/ I Need a Solution? (photo)

My first day on the plastic surgery rotation at Massachusetts General Hospital in 1974, I assisted Bradford Cannon MD, past Chief of Plastic Surgery, on a breast reduction.  At the end of the procedure I asked why it came out kind of square. Brad said that is how they come out.  My next case was assisting the Chief Resident, James W. May Jr. on a breast reduction.  He used the inverted T technique and it came out beautifully round and well shaped.  "I just did the same case with Brad and it came out square and yours came out round. Why?".  James was the perfect Southern gentleman.  He put his hand on my shoulder and told me with all modesty,  the first and most important lesson in my plastic surgery career.  "Luis, if you cut the breast square, they come out square.  If you cut them round, they come out round."

Your pictures should always be in the same position for before and after photos front, angled, and side for better evaluation.

But from what you have supplied it would be reasonable to suspect that the inverted T technique would have been a more prudent choice for the shape and degree of ptosis and the large areolae.  There is more scarring, but in skilled hands the procedure is the most reliable for cases like yours.

The good news is that the inverted T procedure can correct your current condition.  It is unlikely that you or your skin is the problem.  If your result does not look good at the end of surgery on the OR table, it is unlikely to dramatically improve later.

By the way, I told Brad what James said about the square breast.  Without hesitation he scrubbed in on James' next inverted T breast reduction and mastered the technique.  That is what I loved about the Harvard Surgical Service, selfless men of integrity.   Best wishes.  Knowledge is power.  Luis F. Villar MD FACS

Hi jg0729,

     I am sorry you had this very disappointing result.  Your results are due to poorly performed surgery, not poor skin quality or elasticity.   It appears to me that your surgeon attempted to perform a vertical lift (no horizontal incision) and relied on the skin alone to support the lift.  This will not work.  It is critical that the internal architecture is rearranged and suspended independent of the skin.  The skin should not play any significant role in executing this type of lift.

     The good news is that this is all fixable.

Good Luck,

Ary Krau MD FACS

You may require a revision breast lift using the same incisions as your first procedure. This may necessitate more longlasting sutures to provide a corset support for your lower breasts. 

Your breasts unfortunately have not taken on the perfect shape after your original breast lift.  It is difficult to say whether this is your own skin elasticity or the technique used during the original operation.  I would advise a second opInion by a board certified plastic surgeon.  Hopefully a little more skin tightening will get you the perfect shape.  Sorry to hear about your bad experience.  Good luck.

The distance from the bottom of of the areola to the infra mammary crease in a C cup breast is about 6 cm. The picture demonstrates a distance it is significantly longer than this. Operations designed to minimize the length the incision commonly have this as an aesthetic failure. You will need the second mastopexy fixed the problem.

      I would not place implants as this will worsen a poor skin envelope.  In addition, you are happy with the size of your breasts, and implants would only make you larger.  I think that you can probably get a very nice result from a breast lift revision alone.  Find a plastic surgeon with ELITE credentials who performs hundreds of breast lift and breast lift revision procedures each year.  Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results.  Kenneth Hughes, MD Los Angeles, CA

Some patients do indeed have poor skin quality for one reason or another.  The support structures of the skin which would normally support a lift fail to hold the weight of the remaining breast tissue and the skin begins to droop all over again.  In cases like this, I recommend removing as much of the skin as possible with an aggressive lift, placing a conservatively sized breast implant and using an acellular dermal product such as Alloderm or Strattice to support the weight of the implant and reinforce the lift.  I would suggest that you consult with a board certified plastic surgeon to review your options.

 

Good Luck.

 

Good Luck. 

Hi JG and thanks for your post. I can see why you sound frustrated, but you should not lose hope. It looks to me like the technique used was a vertical breast lift and after the surgery the breasts seem bigger. You mentioned that you have no implants. While the elasticity of the breast skin has contributed to your results, perhaps a more aggressive reduction of the skin envelope would have helped. I think you should consider seeing a board certified plastic surgeon for a second opinion. The options you have already mentioned like reducing the weight and cup size seem reasonable. As far as adding a breast implant - you should discuss that with a PS during consultation. Best wishes, Dr. Aldo.

Thanks for your photographs and questions.  Your photographs show that your breasts are "bottoming out" and you will need revision surgery to achieve the kind of results you are after.  Its impossible to determine online whether this occurred due to your skin tone and quality or whether the incorrect surgical approach was used for you.  My impression is that tightening of your skin in the folds under your breasts (infra-mammary folds) should deal with your problem but consultation to confirm this is required. Your best step would be to seek the advice of a fully qualified plastic surgeon who has significant experience in breast lifting procedures.  

I have been doing the vertical ("lollipop") lift for around 20 years and one reason has been to minimize the possibility of what has happened to you.  I have only seen it 1 time since I started doing this, because a critical part of the procedure is to "re-hang" your breast tissue on the pectorals muscle higher up and even overdo it because of how it settles down.  Your skin already proved it can't hold up your tissue, so this way we are not just relying on it.  Self supporting tissue.  It turns out that only one that recurred was around your age.  You may also want to take some extra vitamin C and minerals so you make stronger collagen, which might help stabilize things and reduce the risk of recurrence if you have it done again.  And just so you know.....your tissue is not like a rubber band that can keep stretching.  Good luck!