Already Sagging After Breast Lift and Silicone Implants
Doctor Answers 28
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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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).
Sagging after breast lift or mastopexy
overall your breasts look fine and your plastic surgery results are reasonable. it is not uncommon to get some asymmetry in the nipple position and the shape. all breasts do re-sag to some extent after a breast lift. You might want to let your surgery to heal and then consider a larger implant in order to get a better cleavage.
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.
It seems to me that you had a skin lift with an augmentation. As a result, your scars are stretching, your areolae are stretching, and your breast and implant are bottoming out. Using your existing scars, you can have a "Vertical lift" which plicates the breast tissue on the bottom of the breast and internally lifts the breast - not just uses the skin.
To truly determine what can be done will depend on 1)...
To truly determine what can be done will depend on
1) time from surgery- a minimum of 6 months
2) what your breasts looked like before surgery
3) what level the implants were placed
4) any post operative complications
Revision surgery is an option. The implants can be elevated in position to give more upper pole fullness. The degree as to which the "sagging" can be eliminated is partially dependent on the quality of your tissue. Your implant size will cause some tissue thinning and stretch the skin of the breast to a degree.
With Warm Regards,
Trevor M Born MD
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.