Will Strattice Breast Revision Procedure Give Desired Results?

Strattice? After 1st BA/BL 3 yrs ago, they sat lower than I would have liked on my chest and were bottoming out. I had revision surgery to correct these issues..as well as gain upper pole fullness. My PS said internal bra & donut lift with larger implants were the answer. I'm 3 mo out from revision surgery and very disappointed. My surgeon's opinion is they look fine. I think they are too low..and the left has dropped too much losing all upper fullness and is sagging. I have 400r/450l mods.

Doctor Answers 9

Breast revision surgery

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Revision breast surgery is tricky and difficult. It depends on so many factors including your body's own tissues and the implants themselves. Using larger implants predisposes you to developing early bottoming out and implant descent. Periareolar incisions in general are not a reliable way to produce a sustained lift in my experience. Finally the use of acellular dermal matrices such as strattice may provide patients like yourself extra support. There really isn't long term data on this. It is also fairly expensive so I reserve these for very special cases. I would recommend seeing someone who has extensive experience in revisionary breast surgery.

Dallas Plastic Surgeon

Are you ready for a 3rd surgery after breast implants plus donut lift?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Well, I hope your surgeon didn't actually say they "look fine." He successfully decreased areola size, raised both implants to a higher position, and restored fullness to the upper poles of your breasts. But they don't match!

No body ever matches exactly, but you are justified in being disappointed with your present appearance. Since you are at 3 months post-op after your second operation, there may be additional changes in both breasts, but you need the right breast to drop to match the left (since the left will never go "higher!"), and you already feel that the left is "too low." So even if the right breast drops more than the left and achieves better symmetry, you will feel BOTH breasts are now too low.

Of course, the "desired result" is in the eye of the beholder; your left breast looks good, but you want it higher. Even your right breast looks OK, but it is visibly higher than the left. If you wore an elastic bandeau above your right breast and BELOW the left (safety pin the band to a T-shirt worn over the band), you might be able to support the left breast from any further dropping, while encouraging the right to drop into a more symmetrical position. But as I understand you, although this would make your breasts match better, they would now BOTH be too low! Not as low as your pre-op 2nd surgery (post-op 1st surgery), but still too low.

Thus, re-operation for a third time seems in the cards. I would suggest that you really are asking for a full Wise-pattern mastopexy (breast lift with the "anchor" technique), which will tighten your skin brassiere into a pleasing shape, a higher position for your implants, and an overall "perkier" appearance. Implant size can be adjusted at this time as well. This surgery requires more scars, more cost, and slightly more healing, but probably is what you should have had in the first place, just like my patient in the link below!

Yo will need reision

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

You are not alone with the problem with the lift and implant. By some publication the revision rate for the lift and implant is 40% -100% . Bigger implants will make your problem worse.

Augmentation mastopexy revision

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

I agree with of those who have said that your skin elasticity issues are likely, at least in part, the source of your problem.  Overall, your breasts sit somewhat low on your chest, which I suspect is part of the problem overall as well. I feel that your LEFT breast is the more natural-looking breast and that trying to match the RIGHT breast is going to be difficult at best.  Obviously an in person consultation with a board certified plastic surgeon is the best way to direct you, but I suspect you already know that.  Based only on the pictures I suspect a revision of the mastopexy on the LEFT  and a slight lowering of the fold beneath your breast on the RIGHT would give the most natural result.  I think this would be a long discussion with you as that is seemingly against your goals.  Best of luck to you.

Breast augmentation and mastopexy revision

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Thank you for the question and pictures.

I agree with your plastic surgeon's plan;  some form of “internal bra"  (capsulorraphy)  may be very helpful.

If revisionary surgery is decided upon, it will be very important to communicate your size goals with your surgeon.  In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as “natural” or “C cup” or "fake looking" means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup  size may also be inaccurate.
I 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 press 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.

Which Breast Revision Procedure Will Give Desired Results?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Your photos are a bit confusing. Is the first (on the left) after the 1st operation? And the middle and right one after the second operation? If yes than before the second op you looked OK. I would have just increased your size implant and use a textured. Now after 3 months your are correct that things could have been better. Seek a expert in revision breast surgery. 

Internal bra procedure should correct bottoming out implants

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

The internal bra procedure usually refers to the use of an acellular matrix such as Strattice. This is useful when your own tissues have thinned or are otherwise not strong enough to support the implants. I am not sure from your question whether or not you had this done with the revision. From thebpictures it looks to me like the main issue now is symmetry.

"You can't always get what you want" when it comes to breast revision

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

You won't want to hear this but your body's tissue elasticity just isn't great and you may never be able to have the upper pole fullness you want.  Right now the left implant looks very normal and the right may settle down to match it.  This might not be what you wanted but it would be an appropriate result once the symmetry is better.  This isn't a lifting issue either as your photo shows a reasonable position of the nipple relative to the creases. 

If the right one doesn't settle down you will need another revision of the left side and if you wanted to try to hold it very high up like the right you might be wise to go with Strattice though it will add cost to the revision.

Revision breast lift works.

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}


1)  Of course, you should not do anything for several more months, but I am afraid you will not get reasonable symmetry without another revision.  You may not get exactly the shape and upper pole fullness you want, but you can do better than this.  You may have poor elasticity, but that is not the reason for the unsatisfactory result.

2)  Just going by your photos, and assuming you don't change significantly in the next few months, the fold under the right breast needs to be lowered.  The left nipple needs to be lifted, and the left areola needs to be made smaller.

3)  I know you like the right breast better, but I don't think the left breast can be made to look exactly like the right.  That's why both should be operated on.

4)  You don't need Strattice or other foreign material. It's just a matter of checking for shape and symmetry before the operation is concluded.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

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.