What deformity has caused this issue with my breast and how do I fix?

Question

I had second breast implant and-uplift January24 in Istanbul.. Almost immediately post surgery, I noticed a dip/ indent in left breast, it sits much lower than the other. My surgeon stated was due to incorrect bra use post surgery My surgeon has offered a revision but stated the same issue may occur. I’m apprehensive to return if this issue cannot be resolved. Can someone explain the deformity and how it can be resolved?

Daniel Barrett, MD · Answer

Dear laura332,

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, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Gary M. Horndeski, MD · Answer

The vertical scar of your lift resulted in lifting the nipple-areola complex too high. The mechanical strength of your skin envelope is too weak to hold up your implants and your implants have bottomed out. You have skyward gazing nipples and bottomed out implants. At this time, I recommend explantation and inferior repair of the inframammary fold. I would wait 6 months and consider reaugmentation totally submuscular.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Connie Hiers, MD, FACS · Answer

Your implants are too large and heavy for your tissue and are bottoming out. I suggest going smaller, tightening your inferior pockets, and using mesh for support. Go to someone in your area so you can have proper follow up care.

Hilton Becker, MD · Answer

This is a difficult problem to correct.
The distance from your nipple to the breast fold need to be reduced   6-7 cms .
The implants need to be elevated and supported with mesh  .
You May want to consider smaller implants.

Mats Hagstrom, MD (license on probation) · Answer

First and foremost, I do not recommend traveling long distances for elective surgical procedures.
The number of patients who have issues after surgery, need revision surgery or end up with complications is very real.
There are three variables that determine the outcome of breast augmentation surgery.
The first is the patient’s candidacy for the procedure.
The second is implant selection.
The third and most important variable is provider selection.
As a general statement, anytime, excessively large implants are used the chance of undesirable side effects, complications, and the need for revision surgery will go up.
Likewise, if a lift is done in conjunction with breast augmentation the chance of needing revision surgery or having problems after close-up significantly.
To make a quality assessment, we need quality information.
This should add a minimum include a complete set of proper before and after pictures for each of your previous operations.
If you don’t have before and after pictures, then ask your surgeon to forward the pictures they took.
Anytime there are issues after breast documentation we can almost always trace them back to one or more of the three variables mentioned above.
And your case I think number one is implant selection. I don’t know what the sites of your breast was before surgery, but I’m guessing the diameter of your implant is significantly wider than the natural diameter of your breast.
And I also think the procedure was done in a way where your pectoralis muscle is not able to hold the weight of the implant, and because of that gravity is pushing the implant down and stretching out your skin envelope. Different plastic surgeons have different ways of inserting implants and Often part of the pectoralis muscle is transfected to allow placement of the implant.
If the surgeon is able to leave enough pectoralis muscle that the muscle can hold up to weight of the implant, and this problem doesn’t happen.
Without transacting the pectoralis muscle the implant has a chance of sitting to high so it’s a technical balancing act between the two.
I don’t want to get too technical, but the procedure is done. This Basically determines if this problem happens or not.
The condition you have is often referred to as implants having bottomed out.
It’s not an easy or straightforward condition to correct
It can be done using internal permanent sutures with or without mash or cadaver dermal products like AlloDerm. 
Before considering revision surgery, you should focus your efforts on finding a plastic surgeon who has extensive experience correcting this condition.
That means having multiple in person consultations, asking providers to open up their portfolio and show you lots of before, and after pictures of previous patients who had the same problem with good long-term outcomes.
 The chance of this recurring is if it’s not done correctly and each time you have another procedure things get more complicated.
Your best and most important decision at this point is provider selection.
In the hands of the right plastic surgeon, you should be able to restore this to a quality long-term outcome.
 if you don’t find the right provider, then you’ll be having trouble again and again and the condition will only worsen.
I did not recommend you travel to have revision surgery.
Traveling may be indicated if there’re simply isn’t local talent. 
From my experience, most people in Europe, who go to Turkey for cosmetic surgery do so to save money.
The savings and of being a poor choice if expensive revision surgery becomes indicated.
I’ve seen this too many times to count and I continue to encourage peopleto stay local and always have in person consultations before selecting a provider.
Look for plastic surgeons in your community who have extensive breast surgery experience.
If you don’t know who to go to then start by finding the plastic surgeons who do most of the breast cancer reconstruction in your community.
Plastic surgeons who are good at breast cancer reconstruction are usually good at all aspects of breast surgery.
Schedule several consultations with several different surgeons and insist that they show you their entire collection of before and after pictures of previous patients who had the same condition.
Ask them specifically what the long-term outcome is and what the chances of this recurring.
Ask each provider what their revision policy is.
Best,
Mats Hagstrom MD

What deformity has caused this issue with my breast and how do I fix?

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