Will I Need a Second Breast Lift (Nipples Still Low, Implants Might Be Too Big)?

In order to achieve a perky moderate sized breast in your condition, a more agressive lift will be required and this will involve significantly more scarring. The original condition is more likely related to your long torso, low set breast crease and prolonged nipple to fold distance. The overall position of your breast on your chest is difficult if not impossible to truly change. However, the position of the nipple on the breast can be rotated with relatively small scar if this is your true desire.

         In the context of
baseline asymmetry and efforts to minimize scarring this isn’t an unreasonable
result. Review of your pictures demonstrates pre-operative asymmetry with breast
sag which is worse on the left side than the right side. Post-operatively,
there’s significant improvement, but there’s still minimal residual breast sag
and asymmetry present. In addition, you continue to have concerns about your
breast size and would like to have smaller breasts.

 

         Reducing your breast
implant size will result in loss of support of the overlying breast tissue with
accentuated breast sag. Correction of your sag and residual asymmetry will
require a more extensive breast lift. This will require either a lollipop or
anchor incision with increased scarring.

 

         It’s important to
have good communication with your surgeon to avoid confusion about important
issues like breast size. It’s always difficult to determine breast size by
utilizing cup size because it means different things to different people.

 

         Obvious trade offs
between increased scarring and “perkier breasts” will need to be made. Going
forward, it’s important to have realistic expectations about what, revisionable
surgery can accomplish. When expectations are realistic, patients are usually
satisfied with their surgical result.

Your breasts seem a little low and could be improved by a second lift on the left and an initial one on the right. You would however have some vertical scars. The implants do not seem too big but could be exchanged for a smaller pair if the size is too large for your taste.

Cheekysmiles,

it seems like your surgeon has used large implants in an attempt to avoid the need for a breast lift.  I am not sure why he chose that route, it may have been in an attempt to avoid scars of a more extensive lift.  However, now you do need a more extensive lift.  This would involve adding a vertical scar from your areola to the breast fold under your breast.  Although it has more scarring than just doing a periareolar lift, it is much more effective in reshaping and lifting your breast.

When you see your surgeon, make sure he is a Plastic Surgeon certified by the American Board of Plastic Surgery (the only board in US that can certify plastic surgeons) or the Royal College of Physicians and Surgeons of Canada (the only board in Canada that can certify plastic surgeons).  Then ask to see his before and after pics of patients like you, who had implants and needed a significant lift.

 

Sincerely,

 

Martin Jugenburg, MD

Thank you for the question in pictures.

I agree with you that your nipple/areola are too low  and that additional breast lifting is indicated. Additional breast lifting will require more incisions ( vertical)  and more scarring. This is the classic trade-off that should be considered by all patients undergoing breast lifting surgery.

In regards to achieving your breast size goals communication with your plastic surgeon will be key to achieving the results you are looking for. Unfortunately, the use of words such as  "natural look" or C cup means different things to different people.  Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup  size may also be inaccurate.

In my practice I use goal pictures to communicate with patients.  With this technique patients are able to demonstrate what they are trying to achieve and what type of looks they do not like as well. 
I also use  intraoperative sizers and place the patient in the upright position to evaluate breast size. Use of these sizers also allow me to select the breast implant profile (low, moderate, moderate plus, high-profile) that would most likely achieve the patient's goals. The patient's goal pictures are hanging on the wall, and allow for direct comparison. 
I have found that this system is very helpful in improving the chances of achieving the patient's goals as consistently as possible. 


I hope this helps.

18 year olds are perky, your breasts are not riding low. your torso is long, the implants are where they need to be. you could go smaller and increase the lift by adding a vertical incision below the areola (lollipop). this would also improve your shape (cone vs. flat). my plan, smaller implants with lollipop lift. good luck

I would recommend a "vertical" lift for you in order to bring the areola to the center of the breast mound.  If desired, a smaller implant can be exchanged at that time.

There are several problems here.  Some are likely due to miscommunication with your surgeon and some are unrealistic expectations on your part.  It is never a good idea to ask your surgeon to be a specific cup size.  He will rarely be able to deliver.  Cup sizes are not standardized and vary from bra company to bra company.  I have my patients try on the implants before surgery so they can tell me what size looks good to their eyes.  This is the best way to avoid surprises when it comes to size.  I don't know if you had the chance to try on implants.

Second, you have a long torso with low set breasts.  There is no procedure that will move your breasts up on your chest.  All the lift procedures move the nipple up, not the whole breast.  They will also tighten the skin under the breast to hold the implant higher.  However, over time, the implant will settle again.  The crease of your breast is not moved upward therefore your breast is not moved upward.  If you are looking for your breasts to be higher on your chest, you will be disappointed with any procedure.  Also, by placing implants, you are making your breasts heavier and they will then try to go even lower with time.

I think you would have had somewhat better shape to your breasts with a vertical or lollipop shaped breast lift.  This would have lifted your nipples a little higher and tightened the lower part of your breast more.  If you are going to have another procedure, I would consider adjusting the size of the implants so they are closer to the size you are looking for and having a vertical mastopexy to further raise your nipples and tighten the lower part of your breasts.  Discuss all of this with your surgeon in detail to make sure you understand what surgery can and can not do for you.  Good luck!

Dr. Parham Ganchi

I do not think your interval result is bad.  You had low set breast and you still do.  Getting breast isuue to stay up and add volume is difficult and will not last despite what any surgeons tries to tell you.

It may be as simple as lifting the left areola a bit more.  Not a big deal to do can even be done under local.