Please help, breast lift gone bad. What are my treatment options? (Photo)

Question

Can someone point me to the best breast revision/reconstruction/scar revision doctors in the world. Im unsure my condition is even fixable because ive been turned down by multiple doctors and so far only 1 said he can help but only once i hit a year post op. there is multiple things wrong here but if i can only fix 2 it would be my nipples to be even and scars to be better. they seem to sit high and are to big for my chest. also don't seem to have loose skin. feel my life is over. help please

Gary M. Horndeski, MD · Answer

Your breasts are widely separated and the nipple-areola complexes are asymmetrical. After 6 months from the day of surgery, I would consider a revision. You would need a circumareola approach to revise the scars and move the nipple-areola complexes more medial. You will also need a revision of the inferior curve scars near the inframammary fold. This can be done to pull the breasts down to make them in a more natural position. You may also benefit from simultaneous fat transfers.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Chet Mays, MD · Answer

Thank you for your inquiry!  You breast appear to naturally fall to the side, an internal bra could help with this.  We would love to sit down with you and discuss your concerns.  Schedule a consultation with a Board Certified Plastic Surgeon to help you reach your goals.

John Michael Thomassen, MD · Answer

I would recommend a scar revision with slight reduction in the Nipple-areolar complex.  Now that enough time has passed, a revision can be done with minimal tension on the skin and a more acceptable scar.

Raffy Karamanoukian, MD, FACS · Answer

Our treatments use combination therapy to improve the epidermis and dermis. We see atrophic and hypertrophic scars, as well as scars that have hypo and hyperpigmentation. Our main concern is rebuilding collagen and that is why we use a HIDEF protocol that includes combination therapy. Morpheus 8, scar subcision, fibrous release, fractional laser, CO2 laser, Thulium laser, PDL Vbeam laser, and fractional resurfacing can be used in addition to TCA Cross and chemical peels to further improve skin. Patients should start Melarase AM and Melarase PM for active hyperpigmentation. Always begin with a consultation to discuss the best treatment options for your type of skin. .

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Daniel Butz, MD · Answer

I'm sorry you're not happy with your outcome. Fortunately there are options to improve your result but also limitations. 
Reducing the areolar size with a permanent suture should be feasible and reliable. 
It is typically best to wait at least a year to perform scar revision. Genetics plays a big role in scar formation so if you scarred poorly the first time you'd want to take a lot of additional steps to optimize the future scarring. This can start with preop nutrition, post op tapes, topicals and maybe lasers. 
Lowering the areolar location can be tricky. The only real option is to remove an ellipse of skin from the lower part of the breast, in the breast fold, to pull it down. If everything is really tight that may require a small volume reduction. 
Overall tight incisions can lead to poor scars and more areolar stretch. 
Hope that's helpful.

Camille Cash, MD · Answer

It's best to wait a year to consider scar revision as the appearance can continue to improve as they mature.  A revision to the lift could also be performed to help with the overall shape.  Be sure to see board certified plastic surgeons for the best results.

Darryl J. Blinski, MD · Answer

Photos help a little bit virtual consultation would be much better revision of restless may be accomplished expect fees to range from $10,000-$20,000 again best virtual consult with

Pawel Szychta, MD, PhD, DSc · Answer

I'm sorry you're feeling this way. To find skilled surgeons for breast revision and scar correction, search for board-certified plastic surgeons who specialize in complex breast procedures. Use reputable organizations like the American Society of Plastic Surgeons or the International Society of Aesthetic Plastic Surgery to locate experienced professionals. Consult multiple surgeons to discuss your concerns and potential solutions. Many people have successfully improved their outcomes with revision surgery, so professional help is available.

Mats Hagstrom, MD (license on probation) · Answer

In general plastic surgery outcomes are based on two variables.
The first is the patient candidacy for the procedure in the second is the skill of the surgeon.
Both variables are probably equally as important.
To start with let’s make an assessment on your candidacy for the breast lift.
In someways my assessment of your preoperative pictures is in someways influenced by the outcome of the procedure since I’ve looked at before and after pictures.
That said what I see in your before pictures are the following.1) The breast sit slightly wide on the chest wall.2) there is moderate breast divergence with the nipple pointing outwards slightly more on the left than on the right.
3) The left breast sits slightly higher on the chest wall as measured by the position of the IMF (infra mammary fold). This is consistent with the great majority of people4) both breasts have mild ptosis with moderate pseudo-ptosis. 
The nipple position is fairly good and appears to be at least at the IMF if not slightly above on the frontal view. I’m going to assume that the patient’s desire was to increase fullness in the upper half of the breast.
Considering that the nipple position is in fairly good position, a breast lift was not really indicated.
The best option for restoring volume and the upper half of the breast based on the preoperative pictures would’ve probably been augmentation using a modest or small implant.
A breast lift does not restore volume in the upper half of the breast, but instead lifts the nipple position higher.
There are versions of breast lifts that attempt to increase volume in the upper half of the breast better than traditional versions, but no procedure can increase volume in the upper half of the breast the way implants can. Without knowledge of the discussion during the consultation, we don’t really know what the goal of the procedure was.
In the after pictures, the following features are noted.
1) The nipple position in relationship to the IMF is excessively high in both breasts, but slightly higher in the left. This is direct reflection of the design of the procedure, which was too aggressive in lifting the nipple position. Again I don’t think a breast lift was indicated. 2) The nipple position sits laterally on both breasts 
The appearance of the nipples sitting too far to the side is a direct reflection of the breast divergence, the surgical design and the nipple position being placed to high. if the nipple would’ve been placed in the lower position the divergent look would have been dampened. The fact that the breast sit wide on the chest wall makes the look even more visible.The vertical lim (scar/incision) of the lift design could’ve been placed more immediately, with potentially more medial placement of the nipple position.
Breast divergence can potentially be amplified with aesthetic breast surgery.
This is more common with the projection of implants. In this case it appears to have been, most likely because of the excessive lift and design of the procedure. The noted breast variations in the preoperative pictures do contribute to the overall aesthetic outcome, and this made the procedure more challenging.
There are also major faults of the design and execution of the procedure.
3) The areola incisions were made at 45mm which is probably the same size as preop measurement(my assumption) The tension of the procedure may have widened the areola further. Based on the size of the breast, the areola incision could’ve been made smaller(to get smaller areolas)
I believe a smaller areola may also have created less of a divergent look.
4) there is mild scar hypertrophy around the areolas With minimal hypertrophy in the vertical incision.
There is mild hyperpigmentation making me guess that’s the scars are approximately 7-9 months old. most likely with time both the hypertrophy and hyperpigmentation will improve considering that scars take 12 to 18 months before they are mature.
Of all the aspects of the undesirable outcome of this procedure by far the most challenging aspect is going to be lowering of the areola. There is no ideal procedure to do this.
One option at revision would be to convert the procedure to a wise pattern with somewhat aggressive skin resection along the IMF, and an attempt to shorten the distance between the IMF and the areola. Moving the areola medially without a wise pattern incision may be difficult.
Likewise, reducing the size of the areola may also be challenging without a wise pattern and significant undermining. 
Lowering the areola with a skin graft is possible but would most likely leave an unacceptable aesthetic outcome.The mild scar hypertrophy may improve somewhat with the use of silicone sheeting(tape), but will most likely also improve somewhat over time.In the end, I don’t think you need to search the end of the Earth for the right provider.
Recognize that only limited improvements are possible.
A solid good breast surgeon should be able to help this by simply redoing the procedure. Improving the aspect that can be improved.
Lowering the areola is going to be the most difficult. 
To find the right provider for your revision, I suggest you interview a number of plastic surgeons who seem to have a few decades of experience with practices that have high volumes of breast surgery.
Consider plastic surgeons who do a lot of breast cancer reconstruction in your area.
During Consultation, ask each provider to open up their portfolio and show you as many revision procedures as possible preferably those with similarities to your own situation.
Most likely surgeons are not going to have a lot of situations that mimic your outcome.
You should also ask surgeons to show you as before, and after pictures of previous patient who had similar breast characteristics to your own breast in the before picture.
The best surgeons to do revision work are usually the same surgeons who do the best primary procedures.
A Highly experienced provider should have access to 100s if not, thousands of before, and after pictures to choose from. And the hands of the right provider you should have access to more before and after pictures then you have time to look at during the consultation.
Being shown just a handful of before and after pictures, maybe insufficient to get a good idea of what results look like in the hands of each provider.
Most blessed surgeons, regardless of skill are going to have some outcomes that turned out well.
The goal is never to see the best results of the providers career, but rather to get an idea of what average results look like.
Providers may be apprehensive to show you anything but their best results.
Push them to show you results that didn’t turn out as well as they had hoped.
A confident honest provider should show you these.
You may also ask providers to show you examples of cases where they had to do revisions on their own patients.
 Most patients don’t have a lot of experience consulting with plastic surgeons.
Plastic surgeons on the other hand, even those who don’t have that much experience have had an opportunity to perform lots of consultations.
By interviewing a number of plastic surgeons you’ll get better at the consultation process.
The consultation process goes both ways.
The surgeon needs to assess your candidacy for surgery and convey what they have to offer you.
It is also the patient’s obligation to vet the provider in regards to skill or experience.
Approach the consultation as you are interviewing someone that you’re about to hire to perform a service which is actually exactly what you’re doing.
I don’t know where you live, but if you happen to be close to Southern California, I will give you the name of The plastic surgeon who is better than any other plastic surgeon I’ve ever met during my career.
His name is Mark Kobayashi MD and his practice is in Irvine.
I can vouch for Dr. Kobayashi without reservation.
He is a single-handed, most talented surgeon I have ever known.
If you’re not close to Southern California, I encourage you to look for providers in your community.
I generally do not recommend people travel long distances for elective surgical procedure, though sometimes it may be indicated.
In the end, your outcome is unfortunate.
I think the procedure was somewhat inappropriate, but perhaps you were apprehensive about having implants which I think would’ve been a better procedure.
Perhaps a slight lift with implants would’ve been indicated, but I don’t think a breast lift could’ve restored your breast shape, which is I think what you were hoping to improve.
I hope you find the right provider for your needs.
Finally, I have a few points for anybody considering any permanent irreversible cosmetic surgery procedure.
The first is to always have multiple consultations before selecting a provider.
The biggest mistake I see patients make only one consultation and then scheduling surgery.
Having only one consultation, more or less eliminates the ability to choose a better provider.
 Unfortunately people seem to believe that they can select plastic surgeons by using the Internet.
This simply is not reality.
There’s no correct number of consultations needed to find the right provider.
The more consultations you schedule the more likely you are to find the better provider.
 Bring pictures of yourself to use as reference during the consultation.
This is true no matter what procedure you’re having.
Don’t rely on memory or looking in mirrors to remember what you look like for reference.
Insist that providers show you before, and after pictures of previous patients who had similar body or facial characteristics to your own.
This is we’re having pictures of yourself becomes important.
 Ask providers to describe what makes you a good or less ideal candidate for the procedure and write down each of these variables.
Understanding your own candidacy for the procedure is key and understanding what the procedure can or cannot accomplish.
By understanding your own candidacy for the procedure you’re also able to confirm The providers are showing you examples of patients who have similar characteristics.
For example, if a A patient has significant breast and is shown results of patients whose nipples point straight forward they’re going to be disappointed when their nipples are pointing out to the side after the procedure when this was not dictated by how the procedure was performed, but rather the patient’s candidacy for the operation.
Take notes during the consultation, especially regarding the quality and quantity of before and after pictures.
In the end, the Surgeon is responsible for the outcome of the procedure, but the patient is responsible for selecting that provider.
Being certified plastic surgery with a handful of good reviews, and a few years of experience does not mean somebody has mastered any plastic surgery procedure.
Plastic surgeons are average and average plastic surgery outcomes don’t always look that great.
Exceptional results come from exceptional providers.
Finding an exceptional provider requires interviewing a number of surgeons.
Considering that the results are going to be with you for the rest of your life, the effort to have multiple consultations seems obvious to me.
Above all avoid virtual consultations, which make it almost impossible to vet providers accurately.
When in doubt, slow down and schedule more consultations.
In my opinion, if patients were to schedule at least three consultations and insist on seeing a quality collection of before, and after pictures of previous patients who have similar characteristics, the chance of having a horrific outcome on surgical technique is going to be reduced dramatically.
By having only one consultation Patient eliminates the ability to choose the right provider repaired.
This response was dictated using board recognition.
I apologize about potential grammatical errors and the rambling nature.
I genuinely hope you find the right provider who can help you improve your outcome which as I mentioned is rather unfortunate.
I wish you all the very best,
Matt Hagstrom MD

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