5'9, 173lbs, still sagging after 650cc Inspira & lift 6 months ago - what is needed? (Photos)

This is a complex problem to address. I would recommend removing both implants and allowing the tissues to rest/recoil. After 3-6 months, I would recommend placing significantly smaller implants, placing soft tissue support/internal bra (Galaflex), and performing a breast lift. The placement of very large implants can create significant problems and change the breast shape. In addition, patients that have lost a lot of weight lack intrinsic soft tissue strength that needs to be improved with some sort of soft tissue support scaffold or dermal matrix. I would recommend seeing a board-certified or board-eligible plastic surgeon with actual training in plastic surgery and an aesthetic fellowship. I find it also very beneficial if the surgeon has 3D imaging that can help simulate your revisionary surgery prior to the actual case. Best of luck!

Dear Affectionate667781,
breast revision surgery is the most difficult plastic surgery procedure performed. Botched breast surgery alters normal tissue planes and laxity, the ability of breasts to heal properly, and leaves scar tissue that dramatically affects the level of difficulty of the corrective surgery.Many patients come in to correct poor outcomes from their initial surgeries. The most common problems are due to implant malposition, bottoming out of the implant, poor scarring, and incorrect implant size.While the type of revision required will depend on the result of the previous surgery and the desired result of the patient, some revisions involve extensive pocket repair that may or may not need specialized external bras.If you are considering breast surgery revision, you should speak with a board certified plastic surgeon and have yourself properly assessed. Only after a thorough examination you will get more information and recommendations. Also, you have to make sure that your surgeon understands your breast augmentation goals.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Hi Affectionate,
Do you know if your implant were placed above or below the muscle?When implants (especially as large as a 650) are placed subglandurally, it can result in premature sagging. The skin of a massive weight loss patient has often lost some of its integrity and may need more structure in order to stay in place.
Congratulations on your weight loss and I wish you the best of luck in your search for treatment!
-Dr. Nik

You photos show an improvement in your appearance following the surgery. If further lifting is desired, it could likely be achieved with a secondary and possibly more aggressive lift. Smaller implants would also be suggested.

At this time, I recommend explantation and lift using The Bellesoma Method. The implants are removed, your breast tissue is reshaped creating upper pole fullness, elevated higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained if not injured during your previous surgery. Later, fat transfers or small implants can be placed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Thank you for your question. A large portion of my practice is dedicated to revision breast surgery. It is quite clear from your pictures that you had a poor outcome. It appears that your implants were placed on top of the muscle and effort to fill up the skin envelope. This never results an excellent result. The skin envelope invariably will stretch and bottom out. The lift was completely inadequate. My recommendation would be to have a complete revision with placing the implants under the muscle or performing a pocket revision/capsulorrhaphy and revision mastopexy. I have revised much worse outcomes than yours with excellent results. You should be able to have beautiful breasts. Best wishes to you.

You were never a candidate for a donut/Benelli/circumareolar lift. You had very significant ptosis of your breasts and your tissues were not elastic due to prior weight gain. If you didn't listen to your surgeon's advice to get a full anchor scar breast lift, shame on you. If your surgeon didn't suggest a full anchor scar breast lift, shame on him. Regardless, shame on him for performing this surgery on you. This time, go to a surgeon with integrity and ability to perform the right surgery for you. Now it will be more difficult; along with a revision breast lift, the implant pocket will need repair as well with mesh. Plan on spending more than you did on the first surgery.

Thank you for your pictures and questions. I cannot see in the photos the full dimensions of the "lift" but I only see a scar around the nipple, leading me to believe you had the implants placed and a peri-areolar lift. The reason you have the result you have is due to poor choices in terms of planning. Implant too big, not enough lifting, too much skin left behind. In massive weight loss patients, the skin is usually in excess and is stretched. The best thing to do in these patients is to reduce the skin envelope as much as possible (anchor pattern lift) and then place the implant in a delayed fashion. If you wanted to do it in a single stage, the use of soft tissue support mesh can be helpful. I would suggest seeing someone who specializes in revision breast surgery to discuss how best to move forward.
Good luck!
Dallas Buchanan, MD
VIVIFY plastic surgery
Tampa, FL

It appears you were not lifted enough and used implants that were too large. I would have done the lift only and added the implants later is needed. Trying to do it all at once often leads to the type of result you got

Your implants are way too large and heavy for your stretched out tissue and will just sag. You need to go much smaller and lift. Your tissue will not support heavy implants.