Already Sagging After Breast Lift and Silicone Implants

I finally had a Breast lift and Breast augmentation this Jan. I have 2 kids, 34, 5'7", 160lbs, 38C prior to surgery. I had 550cc Mentor round, moderate profile silicone implants. I feel that they are already sagging and I am unhappy with the lack of roundness on the top and lack of cleavage, and dispoportionate nipples. I don't care if they look natural I want them to look perfect in a bathing suit. What are my options?

Doctor Answers 32

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.


Orlando Plastic Surgeon
5.0 out of 5 stars 14 reviews

Loss of upper pole fullness after breast lift and implants

Thank you for your question.  I agree with others that your result is not different from many people who have had a combination 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

Combined breast augmentation/lifting can be tricky, and having a more "natural" or lower than hoped-for appearance of the breast tissue is not uncommon.  It is often difficult to provide or maintain enough fullness in the upper pole of the breast to please the patient that desires an "augmented" appearance.  in many cases, the use of a larger implant further strains the tissue and causes sagging.  The options include performing a revision mastopexy to tighten the tissues through the same incisions, and considering an implant exchange for a smaller or possibly a textured implant at the same time.

Jeffrey Ridha, MD
Saratoga Springs Plastic Surgeon
5.0 out of 5 stars 23 reviews

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).

Regards

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 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.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 23 reviews

Patience

Your best option is patience and allow proper healing to fully take place. One way to obtain upper pole fullness is to use a larger implant

Frank J. Ferraro, MD
Paramus Plastic Surgeon
4.9 out of 5 stars 40 reviews

Already sagging after breast lift and silicone implants?

Hello! Thank you for your question! The mastopexy (breast lift) procedure raises the breast, which ultimately provides a more youthful and perky breasts. This is done by removing the extra loose skin and rearranging the surrounding breast tissue in order to reshape and support the newly formed breast. At the same time, the nipple-areolar complex (NAC) is raised to the ideal position above the fold beneath your breast (the inframammary fold) as well as being placed at the most projecting portion. Oftentimes with age or following pregnancy, the NAC becomes widened and enlarged. This may be reduced in size during the breast lift procedure.

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!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 21 reviews

Textured implants may improve longevity of results

A breast lift and implant placement are two procedures that essentially fight each other. 

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.

Agree with my colleagues to a certain degree

You are asymmetrical and have bottomed out.  After all, you are asking for your skin to support your breasts and a relatively large implant.   You are NOT sagging.  If it is superior fullness that you desire, I might flip your moderate profile implants to a moderate plus implant and go to a smaller size.  An implant  with a base diameter of "x", centered on the nipple will not fit into a pocket where X is larger than the distance between your nipple and inframammary crease without the bottom portion stretching.   Good luck. 

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.