Should I have a revision with the same surgeon? (photos)

Question

I lost about 90lbs 5 years ago and had a mastopexy with implants and abdominoplasty in January of 2022. I've had a lot of upper abdominal skin laxity since the surgery, my breasts seem too low on my rib cage and they fall to the side. The 75 cc differences in my implants is noticeable. Not pleased with the results but my surgeon is. I'd like my breast higher and brought towards my middline and the upper skin tightened without lowering my breasts. Am I being unreasonable?

Alan Gonzalez, MD, FACS · Answer

Hello @danimoo43, thank you for your question. If you're not satisfied with your initial surgeon's assessment or feel that your expectations were not met, it may be appropriate to seek a second opinion from another board-certified plastic surgeon. When considering revision surgery, it's important to consider several factors, such as the surgical technique used during the initial surgery. It's also important to establish a surgical plan that meets your needs and expectations.  Your surgeon should be able to provide you with a clear explanation of the surgical plan and the expected outcomes, as well as the potential risks and benefits of the procedure.   Best wishes! Alan Gonzalez MD. American Society of Plastic Surgery Member (ASPS),  International Federation for Adipose Therapeutics and Science” Member (IFATS), Colombian Society of Plastic Surgery member (SCCP).

Brian K. Reedy, MD · Answer

Thanks for your question!
Reach out to your surgeon to discuss your concerns. Let him/her know  that you are not happy with the results and may want a revision.  Best wishes!

Zoran Potparic, MD · Answer

Soft tissues, including skin, have significantly decreased elasticity after weight loss. For that reason result after abdominoplasty and, in particular, breast lift, may not be long lasting and may need revision. Good example is your breast; new breast lift and fixation of inframammary fold will be needed. In order to tighten vertical folds of abdomen (horizontal laxity) a skin excision in the midline, with scar extended from sternum to mons, is needed. The same effect may be achieved with two excsions on each side of torso, extending from breasts to hips. It is difficult to evaluate your result without before surgery images, but it seems to be very much within average for someone loosing 90 lbs. Hope this helps.

Connie Hiers, MD, FACS · Answer

I would suggest going back to your surgeon and discussing your concerns. You did not show your before photos, but your breasts appear to naturally sit somewhat low on your chest and the bases cannot be raised. a vertical component could be added to your abdomen to tighten excess skin, or you could have the posterior surgery done for tightening.  The tummy tuck alone does not remove all the excess skin from the back.

Camille Cash, MD · Answer

Congratulations on your impressive weight loss!  With significant weight loss sometimes a revision is needed due to the laxity of the skin.  If you are uncomfortable having a revision with the same surgeon I encourage you to visit a few board certified plastic surgeons near you for a consultation.  Discuss your concerns and what you could expect in terms of results.

Mats Hagstrom, MD (license on probation) · Answer

To make an assessment on the outcome of a plastic surgery procedure we need to see proper before and after pictures. If you don’t have before and after pictures, then ask your surgeon to forward the ones they took. Once we have before and after pictures then we can begin to make an assessment on the outcome of your procedure. Your mastopexy looks very typical and looks like it was done as a quality procedure. I think your result is above average. I think it would be very fair to pay for a revision if you want the skin tightened because your surgeon did the procedure correctly. Everybody stretches a bit after surgery and surgeons take this into account when doing the procedure. Pulling skin excessively tight during the first procedure. Put patients at risk for wound. Healing complications.
 Your tummy tuckLooks like it has sone horizontal skin laxity in the upper abdomen. That will be challenging to correct without redoing the procedure or adding a “reverse tummy tuck”( something I do not recommend) 
If your surgeon is not meeting your needs then consider scheduling in-person second opinion consultations. 
Your concerns are a bit complex for posing on realself if you want a quality response. 
Best,
Mats Hagstrom, MD

Derek Fletcher, MD - Account Suspended · Answer

I suggest you get a second opinion.  Achieving 90 pound weight loss is an exceptional achievement.  However, most people experience significant skin laxity following significant weight loss.  This often results in the skin stretching out within the first year of their abdominoplasty and breast lift that can effect the quality of the results for both procedures (especially if the breast lift is combine with an augmentation).  The main question is whether or not your skin has enough integrity to make a revision surgery worth it.

Should I have a revision with the same surgeon? (photos)

Answers (7)

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