Already Sagging After Breast Lift and Silicone Implants
Doctor Answers 43
Only a revision will give you what you are looking for.
It seems that your implants have bottomed out and there is significant asymmetry in the size an location of your nipples. I would encourage you to wait at least 6 months from your original surgery to allow things to settle. Then I would do a revision mastopexy to make the nipple areolar complex the same size and location. I would bet you have silicone gel implants that are smooth walled which allows them to move down the chest wall. In my experience I have found replacing these with silicone gel implants that are textured and using a drain until the pocket closes down on the implants can help maintain the higher fuller position which you are seeking.
Loss of upper pole fullness after breast lift and implants
It is too early to make a decision about revision. However if you want more upper pole fullness some form of revision will be necessary. Wait until you're 6 months postop for full healing before making a decision. Your 550 cc breast implants should be large enough and adequate to give you upper pole fullness. Most likely at 6 months a revision to remove more skin from the bottom portion of your breast to lift the implants will be required. Please discuss your concerns with your plastic surgeon.
Augmentation Mastopexy Bottoming Out
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Textured implants may improve longevity of results
The breast implant is used to make the breast larger and stretches the skin. The breast lift procedures is used to reshape the breasts by taking skin out and tightening the tissue. Because of these procedures really trying to accomplish opposite things long terms results for patients can be disappointing.
A textured breast implant (more some manufacturers than others) can often adhere to the surrounding tissue and breast pocket and stay in position longer. This implant combined with a breast lift can be a powerful combination for longer term results.
Revision Surgery Following Breast Lift & Augmentation
Breast lift performed in combination with breast augmentation is one of the more difficult procedures performed in plastic surgery. When these procedures are performed in combination a large number of variables exist that make this procedure complicated. For these reasons, many surgeons won’t perform these operations together. When they are performed together surgeons realize that secondary procedures will often be necessary.
Your pictures indicate a reasonable result for this type of procedure; however several areas of concern are noted. There is obvious asymmetry, with the right breast and areola being larger than the opposite side. This will eventually require a larger implant on the left side with reduction of the right areola. This type of revision should not be undertaken for at least six months.
Some of your post-operative concerns can’t be addressed with revisional surgery. For instance, recurrent sag and loss of upper breast fullness are related to the biologic behavior of your tissue and size of your breast implants. Using a larger implant might help in the short term, but would make the problem worse over time. Another example is cleavage. This is determined by the position of the areola, which can’t be easily manipulated.
It’s important to have realistic expectations. It’s fair to say that asymmetry can be corrected and scars can be revised. Changes in the breasts resulting from biologic wound healing tendencies and gravity aren’t easily changed. It’s important that you discuss your concerns with your plastic surgeon so an appropriate treatment plan can be formulated to optimize your result.
Breast lift revision or larger breast implant
Since you stated the surgery was in Jan., I assume of 2009.
After 6 months of healing I would revise the inverted T incision, by removing more in the vertical dimension. This should elevate the breast more giving a fuller upper pole effect.
Other choices are a 600 to 700 cc implant (I feel a poor alternative but it is still an option).
It can be difficult to fight gravity, but a revision may help
Breast lift results
No breast lift result is perfect. I do see your asymmetries and irregularities of the nipple areola complex. Fullness in the upper pole usually means a bigger implant with the lift, but it never stays up as high as I think some patients expect. And I have to say "natural" breasts do not stay that high either unless a bra is puschng them up.
Already sagging after breast lift and silicone implants?
It is common for the breast to lose its firmness and uplifted appearance over time, which is also accentuated with age, pregnancy/breast feeding, weight gain/loss, and gravity. This results in breast ptosis, or sagging of the breast, with a “deflated” appearance. Women seek the mastopexy procedure to regain the previous youthful appearance of her breasts and women report increased confidence, self-esteem, and femininity once achieving this desired shape and fullness. Breast lifts may or may not be performed with implants – the implant would add increased size but also greater fullness in the upper pole of the breasts which creates more cleavage.
I would discuss your concerns with your plastic surgeon. Increased size of the implants as well as laxity of the native skin do cause increased stretching inferiorly. Revisions certainly may be considered - allow your surgeon to examine and evaluate you and then go over which procedure(s), if any, will be the right one for you. Best wishes for a terrific result!
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