Is this as good as it gets? (photos)

November 2013 I had saline implants under the muscle, with breast lift. R/330cc L/300cc. 08/14 had an in office procedure under local due to right sag to side. Performed mini lift. Did not work, there was no change. Two weeks post op doctor says there is nothing more he can do, my skin is aged and damaged, tissue is to thin. I am not happy with the outcome especially with the right. I am 51, am I really damaged? Is this really as good as it gets? Can anything be done to make them look better?

Doctor Answers 13

"Mini-lift" yields "mini" results

In our specialty most things mini do not deliver what really needs to be done in 90% of our practices.  With that said, I am sorry to say, you do not have a great result in part due to smooth round saline implants that will drop (because they do not grip the soft tissue as do textured devices), but mostly the reason is the lift.  Your augmentation-lift in my opinion, needs to be the reverse (lift-augmentation). You have existing grade 2 ptosis or breast hanging below the crease and therefore the result illustrated shows that implants do not provide any lift, rather they hang lower.
One option is to remove the implants under local and let the pockets heal and return to have a full breast lift.  At that time place a textured shaped implant of the highly cohesive type such as Sientra textured shaped round base gel.  It is the best implant on the market to date, in my opinion. 

Charlotte Plastic Surgeon
4.8 out of 5 stars 80 reviews

Room for improvement

Acceptance of results are not only a function of patient's variables, but also the experience of the surgeon.  Although you were somewhat complicated preoperatively having some characteristics of tubular breast deformity, I believe significant improvement can be achieved.  With a more aggressive lift and higher implant placement, you can achieve a more youthful breast shape having better cleavage and upper pole fullness.
Ary Krau MD FACS

Ary Krau, MD, FACS
Miami Plastic Surgeon
4.8 out of 5 stars 269 reviews

Different Placement Approach and a Lift May Restore Volume

I am sorry to read of your disappointment. The #sagging or #flattening of current implants can occur for many reasons.  Some include the #size of the breast and implant,  #weight of the breast and implant, #gravity, #age and/or aging, #weight loss and weight gain.  #Tissue integrity (i.e. some women are more prone to experience sagging due to weakness of their skin and breast #tissue at the fold).  In regards to implants alone, this is usually said to be mistake by patients reflecting back at the decision. Most breasts will look larger and more droopy with solely implants. They will sag more and sooner, due to the sudden and excess weight. At times it's possible for a “Snoopy” breast or double bubble to develop as a result. There are a variety of techniques for a #BreastLift. I prefer to use the short scar technique, “#lollipop scar” or “#donut lift” rather than the majority of surgeons in the United States that use an anchor pattern lift which involve more significant scarring. Although the “anchor-shape” or inverted “T” incision is still more popular in the United States, it represents an older technique with extensive #scarring and a less optimal result in many cases.
It is imperative you select a plastic surgeon who is #board-certified and has a great deal of experience with breast #augmentation and the incision type, #implant placement, and implant type. Plastic surgeons who have specialized in breast surgery and cosmetic surgery are suitable to perform your breast augmentation. Aside from checking board-certification, it is suggested that you look at before and after photos of the surgeons actual patients, and read patient reviews. Gathering all of this information will help you make a well-informed decision.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 94 reviews

Your need a meaningful lift

Thank you for your picture.  Yes your breast can be improved.  You need a significant and appropriate lift to improve your breast shape and size

Can my breast lift with implants be improved?

You still have considerable sag. A revision breast lift should definitely be able to give you perky breasts. I am not sure what was done, but it was too conservative.  The minor revision you had was not adequate. You need an inframammary fold scar ( anchor scar), with repositioning of implants, and control of the distance from nipple to the fold, as well as higher positioning of the nipple which can only be achieved by a full revision in the operating room

Breast Lift

You have had an inadequate lift.  You need a more aggressive mastopexy under general anesthesia.  You should expect a better outcome.  

Revision lift

A wise pattern mastopexy or lift is necessary to give you a better breast shape.  This is a bit more extensive and not possible under local anesthesia.  It will gather up the excess skin on your lateral breast pole and correct this lateral ptosis you still experience.

Can you get improvement in your breast lift results?

From looking at your before and after photos, I suspect you have lost a lot of weight prior to your surgery. I say this because your pre-op breasts appear similar to what I see in my weight loss patients. I think that a revision may offer improvement in your results. I am unclear exactly what your "mini-lift" involved, but there are many techniques that are designed to help improve breasts like yours. Your surgeon should be experienced in breast lifts and also breast lifts in weight loss patients. I agree with my colleagues that at this point you need to wait 6-9 months to allow more healing. At that point you may consider a second opinion about a revision lift. 

Breast lift

I think at this point you need to allow it to heal. Knowing exactly what was done would be helpful. A revision can probably be done in 4-6 months.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

Revision may help

You likely need a revision.  Doing a lift with implants in one stage surgery, can often times not result in an optimal outcome and requires a revision.  It is possible that your skin is not supporting the implants, but a proper lift should reposition the breast tissue and avoid relying on the skin to support the lift.  You should seek a board certified plastic surgeon who does a lot of breast revision surgery.

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.